Provider Demographics
NPI:1821833930
Name:BAKER, SAMUEL LAYNE (PHARMD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:LAYNE
Last Name:BAKER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 SAGAMORE PKWY W
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-1458
Mailing Address - Country:US
Mailing Address - Phone:765-497-3551
Mailing Address - Fax:
Practice Address - Street 1:512 SAGAMORE PKWY W
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-1458
Practice Address - Country:US
Practice Address - Phone:765-497-3551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26030766A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist