Healthcare Provider Details

I. General information

NPI: 1881990166
Provider Name (Legal Business Name): ROGER ERIC BAKER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2011
Last Update Date: 02/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 BLOWING ROCK BLVD
LENOIR NC
28645-3709
US

IV. Provider business mailing address

875 BLOWING ROCK BLVD
LENOIR NC
28645-3709
US

V. Phone/Fax

Practice location:
  • Phone: 828-754-2124
  • Fax:
Mailing address:
  • Phone: 828-754-2421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19660
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: