Provider Demographics
NPI:1255301529
Name:BAKER, REXX ALLEN (RPH)
Entity Type:Individual
Prefix:MR
First Name:REXX
Middle Name:ALLEN
Last Name:BAKER
Suffix:
Gender:M
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:PO BOX 714
Mailing Address - Street 2:
Mailing Address - City:CLINTWOOD
Mailing Address - State:VA
Mailing Address - Zip Code:24228-0714
Mailing Address - Country:US
Mailing Address - Phone:276-926-8999
Mailing Address - Fax:
Practice Address - Street 1:#1 MAIN STREET
Practice Address - Street 2:JETTIE BAKER BLDG.
Practice Address - City:CLINTWOOD
Practice Address - State:VA
Practice Address - Zip Code:24228-0714
Practice Address - Country:US
Practice Address - Phone:276-926-6707
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202004798183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist