Provider Demographics
NPI:1295757557
Name:BARKER, RONNIE WAYNE (RPH)
Entity type:Individual
Prefix:MR
First Name:RONNIE
Middle Name:WAYNE
Last Name:BARKER
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 385
Mailing Address - Street 2:103 S. MAIN
Mailing Address - City:MERIDIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76665-0385
Mailing Address - Country:US
Mailing Address - Phone:254-435-2772
Mailing Address - Fax:254-435-2545
Practice Address - Street 1:103 S. MAIN
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:TX
Practice Address - Zip Code:76665-0385
Practice Address - Country:US
Practice Address - Phone:254-435-2772
Practice Address - Fax:254-435-2545
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23021183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX142647Medicaid