Provider Demographics
NPI:1740317585
Name:BAKER EXPRESS PHARMACY, LLC
Entity type:Organization
Organization Name:BAKER EXPRESS PHARMACY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:RITTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-889-3353
Mailing Address - Street 1:744 S MISSISSIPPI AVE
Mailing Address - Street 2:
Mailing Address - City:ATOKA
Mailing Address - State:OK
Mailing Address - Zip Code:74525-3355
Mailing Address - Country:US
Mailing Address - Phone:580-255-3784
Mailing Address - Fax:580-252-6278
Practice Address - Street 1:3344 N HWY 81
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-8914
Practice Address - Country:US
Practice Address - Phone:580-255-3784
Practice Address - Fax:580-252-6278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X, 3336L0003X
OK1351503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100244790AMedicaid
OK100244790BMedicaid
1231330001Medicare PIN
1231330001Medicare NSC
OK100244790BMedicaid
3716757OtherOTHER ID NUMBER