Provider Demographics
NPI:1376368720
Name:BAKER, TRAZI AUGUST (RPH)
Entity type:Individual
Prefix:
First Name:TRAZI
Middle Name:AUGUST
Last Name:BAKER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1722 W 600 S
Mailing Address - Street 2:
Mailing Address - City:NEW PALESTINE
Mailing Address - State:IN
Mailing Address - Zip Code:46163-9585
Mailing Address - Country:US
Mailing Address - Phone:317-410-2635
Mailing Address - Fax:
Practice Address - Street 1:4545 LAFAYETTE RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-2033
Practice Address - Country:US
Practice Address - Phone:317-328-0325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26019106A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist