Provider Demographics
NPI:1336747872
Name:JORDON BAKER ACQUISITIONS, INC.
Entity Type:Organization
Organization Name:JORDON BAKER ACQUISITIONS, INC.
Other - Org Name:ROAN MOUNTAIN PHARMACY OF BAKERSVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JORDON
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:423-772-3591
Mailing Address - Street 1:8251 HIGHWAY 19 E
Mailing Address - Street 2:
Mailing Address - City:ROAN MOUNTAIN
Mailing Address - State:TN
Mailing Address - Zip Code:37687-3343
Mailing Address - Country:US
Mailing Address - Phone:423-772-3591
Mailing Address - Fax:
Practice Address - Street 1:604 S HWY 226
Practice Address - Street 2:
Practice Address - City:BAKERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28705
Practice Address - Country:US
Practice Address - Phone:828-820-8058
Practice Address - Fax:931-401-4671
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JORDON BAKER ACQUISITIONS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-16
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy