Individual
MYA BAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4710 JOHNSTON STREET, RITE AID PHARMACY, LAFAYETTE, LA 70503
(337) 988-7284
Mailing address
4710 JOHNSTON ST, LAFAYETTE, LA 70503-4541
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
021218
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
021218
PHARMACIST LICENSE
LA
Enumeration date
08/28/2015
Last updated
08/28/2015
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