Provider Demographics
NPI:1952548794
Name:BAKER, JEFFERY (REG PHARMACIST)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:
Last Name:BAKER
Suffix:
Gender:M
Credentials:REG PHARMACIST
Other - Prefix:DR
Other - First Name:J
Other - Middle Name:
Other - Last Name:B
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4913 KARINGTON PLACE CT
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-7106
Mailing Address - Country:US
Mailing Address - Phone:314-892-2511
Mailing Address - Fax:
Practice Address - Street 1:4913 KARINGTON PLACE CT
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-7106
Practice Address - Country:US
Practice Address - Phone:314-892-2511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-15
Last Update Date:2009-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO040004183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist