Provider Demographics
NPI:1629812011
Name:BAITY, THEODORE COLE
Entity type:Individual
Prefix:
First Name:THEODORE
Middle Name:COLE
Last Name:BAITY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8416 LISMORE EAST DR APT C
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-9323
Mailing Address - Country:US
Mailing Address - Phone:317-709-8666
Mailing Address - Fax:
Practice Address - Street 1:1290 N STATE ROAD 135
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-1003
Practice Address - Country:US
Practice Address - Phone:317-709-8666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN67036483A183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician