Provider Demographics
NPI:1841805660
Name:BARNES, RAE ANN (PHARMD)
Entity Type:Individual
Prefix:
First Name:RAE
Middle Name:ANN
Last Name:BARNES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:757 NE ALAMEDA AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-5627
Mailing Address - Country:US
Mailing Address - Phone:406-600-0100
Mailing Address - Fax:
Practice Address - Street 1:913 NE GARDEN VALLEY BLVD
Practice Address - Street 2:PHARMACY
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471
Practice Address - Country:US
Practice Address - Phone:541-440-1000
Practice Address - Fax:541-440-1204
Is Sole Proprietor?:No
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0017936183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist