Provider Demographics
NPI:1982396305
Name:BAKER, BRETT COLLIN (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:COLLIN
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 1:814 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-4527
Mailing Address - Country:US
Mailing Address - Phone:580-223-7636
Mailing Address - Fax:580-223-0320
Practice Address - Street 1:814 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-4527
Practice Address - Country:US
Practice Address - Phone:580-223-7636
Practice Address - Fax:580-223-0320
Is Sole Proprietor?:No
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK17696183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist