Provider Demographics
NPI:1356664908
Name:BAKER, JORDON THOMAS (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:JORDON
Middle Name:THOMAS
Last Name:BAKER
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:ROAN MOUNTAIN PHARMACY
Mailing Address - Street 2:8251 HIGHWAY 19 E
Mailing Address - City:ROAN MOUNTAIN
Mailing Address - State:TN
Mailing Address - Zip Code:37687
Mailing Address - Country:US
Mailing Address - Phone:423-772-3591
Mailing Address - Fax:423-772-4596
Practice Address - Street 1:ROAN MOUNTAIN PHARMACY
Practice Address - Street 2:8251 HIGWHAY 19E
Practice Address - City:ROAN MOUNTAIN
Practice Address - State:TN
Practice Address - Zip Code:37687
Practice Address - Country:US
Practice Address - Phone:423-772-3591
Practice Address - Fax:423-772-4596
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-10
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37007183500000X
NC20475183500000X
TN42799183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist