Provider Demographics
NPI:1871697060
Name:BAXTER, EMMETT FRANCIS (REGISTERED PHARMACIS)
Entity type:Individual
Prefix:
First Name:EMMETT
Middle Name:FRANCIS
Last Name:BAXTER
Suffix:
Gender:M
Credentials:REGISTERED PHARMACIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 180
Mailing Address - Street 2:
Mailing Address - City:MCKENNEY
Mailing Address - State:VA
Mailing Address - Zip Code:23872-0180
Mailing Address - Country:US
Mailing Address - Phone:804-478-4771
Mailing Address - Fax:
Practice Address - Street 1:10359 DOYLE BLVD
Practice Address - Street 2:
Practice Address - City:MCKENNEY
Practice Address - State:VA
Practice Address - Zip Code:23872-0180
Practice Address - Country:US
Practice Address - Phone:804-478-4771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202004545183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist