Provider Demographics
NPI:1811668254
Name:BAKER, DAPHANY ROSEANNA
Entity type:Individual
Prefix:
First Name:DAPHANY
Middle Name:ROSEANNA
Last Name:BAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3813 DYLAN PL
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40514-1062
Mailing Address - Country:US
Mailing Address - Phone:859-219-0102
Mailing Address - Fax:
Practice Address - Street 1:3813 DYLAN PL
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40514-1062
Practice Address - Country:US
Practice Address - Phone:859-219-0102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-24
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY022293183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist