Baker Pharmacy LLC
Organization Active NPI Community/Retail Pharmacy · Macclenny, FL
NPI 1689219917 · NPPES record last updated Nov 11, 2019
Key facts
- NPI
- 1689219917
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- Legal business name
- BAKER PHARMACY LLC
- Practice address
- 698 W Macclenny Ave Ste 682
Macclenny, FL 32063-2092 - Phone
- (904) 314-3288
- NPI assigned
- Nov 11, 2019
- Organization subpart
- No
Authorized official
- Name
- Mr. Pavankumar Banoth
- Title
- Owner
- Phone
- (904) 314-3288
Practitioners 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200820001819 | FL | Part B Supplier - Pharmacy | 3577989508 | Practice locations: Macclenny, FL |
National Provider Directory
Locations
698 W Macclenny Ave
Ste 682
Macclenny, FL 32063
Phone (904) 314-3288
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | Yes |
Addresses
Primary practice location
698 W Macclenny Ave Ste 682
Macclenny, FL 32063-2092
Mailing address
698 W Macclenny Ave Ste 682
Macclenny, FL 32063-2092
Phone (904) 314-3288
Other providers in Macclenny, FL
- Baker County School Board
- Baker County School Board
- Baker County School Board
- Baker County Schools
- Baker Emergency Group LLC
- Baker Restorative PLLC
- Latoya D Barnes
- Aron Croslin Bell
- Samitria Latrice Bell
- Deborah Lynn Bellino
All providers in Macclenny, FL · Community/Retail Pharmacy in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 11, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.