| NPI | 1366628513 |
|---|---|
| Former Name | THEA MARIE BAKER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: PA RP441361) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP441361) |
| Enumeration Date | 2008-01-18 |
| Last Update Date | 2024-02-07 |