1336420538 NPI number — STEPHANIE J BAKER RPH

Table of content: STEPHANIE J BAKER RPH (NPI 1336420538)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336420538 NPI number — STEPHANIE J BAKER RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAKER
Provider First Name:
STEPHANIE
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RPH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336420538
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
905 S COLLEGE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RENSSELAER
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47978-3006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-866-0466
Provider Business Mailing Address Fax Number:
219-866-0456

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 SAGAMORE PKWY W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST LAFAYETTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47906-1446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-497-2300
Provider Business Practice Location Address Fax Number:
765-497-2311
Provider Enumeration Date:
08/31/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  26019934A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 26019934A . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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