Brandon Baker
Individual provider Active NPI Pharmacist · Brookhaven, MS
NPI 1083278089 · NPPES record last updated Apr 24, 2019
Key facts
- NPI
- 1083278089
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- E12981 (MS)
- Practice address
- 428 Highway 51 N
Brookhaven, MS 39601-2351 - Phone
- (601) 833-7455
- NPI assigned
- Apr 24, 2019
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E12981 | MS | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Larue'S Discount Drugs | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | E12981 | MS | Yes |
Addresses
Primary practice location
428 Highway 51 N
Brookhaven, MS 39601-2351
Mailing address
428 Highway 51 N
Brookhaven, MS 39601-2351
Phone (601) 833-7455
Other providers in Brookhaven, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 24, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.