Provider Demographics
NPI:1831405232
Name:BAKER, MONICA R (PHARM D)
Entity type:Individual
Prefix:MISS
First Name:MONICA
Middle Name:R
Last Name:BAKER
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2636 RYAN ST
Mailing Address - Street 2:WALGREENS #6219
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-7326
Mailing Address - Country:US
Mailing Address - Phone:337-433-4178
Mailing Address - Fax:
Practice Address - Street 1:2636 RYAN ST
Practice Address - Street 2:WALGREENS #6219
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-7326
Practice Address - Country:US
Practice Address - Phone:337-433-4178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-23
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16656183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist