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General NPI Number Information
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NPI Number | 1295735314
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Entity Type | Individual
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Provider Name | MATTHEW R BACKER PHARM D
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Gender | Male
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Dates
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Enumeration Date | 07/29/2005
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 330 CHILOQUIN BLVD
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City | CHILOQUIN
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State | OR
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Zip | 97624-6773
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Country | US
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Telephone | 800-552-6290
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Fax |
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Provider Business Mailing Address
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Address Line | 3949 S 6TH ST
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City | KLAMATH FALLS
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State | OR
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Zip | 97603-4746
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Country | US
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Telephone | 800-552-6290
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Fax | 541-880-0560
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 11103
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License Number State | NE
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