Provider Demographics
NPI:1740880558
Name:YASEEN, BAKER
Entity type:Individual
Prefix:
First Name:BAKER
Middle Name:
Last Name:YASEEN
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 1:6707 CEDAR LN APT 3
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-3338
Mailing Address - Country:US
Mailing Address - Phone:630-570-1150
Mailing Address - Fax:
Practice Address - Street 1:930 MOUNT PROSPECT PLZ
Practice Address - Street 2:
Practice Address - City:MT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-2652
Practice Address - Country:US
Practice Address - Phone:847-590-0011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051303129183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist