Provider Demographics
NPI:1023364379
Name:BAKKER, REBECCA B (RPH)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:B
Last Name:BAKKER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 MAIN ST W
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54806-1512
Mailing Address - Country:US
Mailing Address - Phone:715-682-3123
Mailing Address - Fax:715-682-6494
Practice Address - Street 1:522 MAIN ST W
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806-1512
Practice Address - Country:US
Practice Address - Phone:715-682-3123
Practice Address - Fax:715-682-6494
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN114371183500000X
WI1430140183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist