Provider Demographics
NPI:1730775149
Name:BAKKER, KAITLYNN ANNE
Entity type:Individual
Prefix:
First Name:KAITLYNN
Middle Name:ANNE
Last Name:BAKKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E STATE ROAD 231
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-7495
Mailing Address - Country:US
Mailing Address - Phone:219-718-3034
Mailing Address - Fax:
Practice Address - Street 1:100 E STATE ROAD 231
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-7495
Practice Address - Country:US
Practice Address - Phone:219-662-8854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-19
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26029260A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist