Provider Demographics
NPI:1801119722
Name:BAKER, TIMOTHY GLENN
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:GLENN
Last Name:BAKER
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 1:52 SPARKYS LN
Mailing Address - Street 2:
Mailing Address - City:LEEPER
Mailing Address - State:PA
Mailing Address - Zip Code:16233-3018
Mailing Address - Country:US
Mailing Address - Phone:814-744-7545
Mailing Address - Fax:
Practice Address - Street 1:22631 ROUTE 68
Practice Address - Street 2:SUITE 30
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214-4068
Practice Address - Country:US
Practice Address - Phone:814-226-9860
Practice Address - Fax:814-226-4806
Is Sole Proprietor?:No
Enumeration Date:2010-03-05
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP037274L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist