Jessica Baker, PHARMD
Individual provider Active NPI Pharmacist · Grundy, VA
NPI 1154961241 · NPPES record last updated Oct 26, 2023
Key facts
- NPI
- 1154961241
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 0202217896 (VA)
- Practice address
- 1179 Riverview St
Grundy, VA 24614-9481 - Phone
- (276) 244-3014
- NPI assigned
- Jan 7, 2020
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 29053 | NC | MD | Pharmacist |
| 0202217896 | VA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wal-Mart Stores East LP | Past |
Accepting new patients | |
| Wal-Mart Stores East, LP | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 0202217896 | VA | Yes |
| Pharmacist | 183500000X | 29053 | NC |
Addresses
Primary practice location
1179 Riverview St
Grundy, VA 24614-9481
Mailing address
7702 Slate Creek Rd
Grundy, VA 24614-6409
Other providers in Grundy, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 26, 2023. 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.