Provider Demographics
NPI:1396897435
Name:BAKER, RONALD L (RPH)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:L
Last Name:BAKER
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 1:15310 E NORTHRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:NE
Mailing Address - Zip Code:68037-2866
Mailing Address - Country:US
Mailing Address - Phone:402-234-2767
Mailing Address - Fax:402-234-2767
Practice Address - Street 1:757 W BROADWAY
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51501-4103
Practice Address - Country:US
Practice Address - Phone:712-328-3277
Practice Address - Fax:712-325-1469
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA14339183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist