Provider Demographics
NPI:1639112444
Name:JORDON BAKER ACQUISITIONS, INC.
Entity Type:Organization
Organization Name:JORDON BAKER ACQUISITIONS, INC.
Other - Org Name:ROAN MOUNTAIN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JORDON
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-772-3591
Mailing Address - Street 1:8251 US HIGHWAY 19E
Mailing Address - Street 2:
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 1:8251 US HIGHWAY 19E
Practice Address - Street 2:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ019339Medicaid
TN6106750001Medicare NSC