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General NPI Number Information
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NPI Number | 1689954752
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Entity Type | Organization
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Legal Business Name | BAKER CITY PHARMACY LLC
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Dates
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Enumeration Date | 08/22/2011
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Last Update Date | 02/05/2014
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Provider Practice Location Address
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Address Line | 1920 RESORT ST
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City | BAKER CITY
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State | OR
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Zip | 97814-2726
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Country | US
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Telephone | 541-523-5231
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Fax |
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Provider Business Mailing Address
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Address Line | 1920 RESORT ST
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City | BAKER CITY
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State | OR
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Zip | 97814-2726
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Country | US
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Telephone | 541-523-5231
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | JERRY YENCOPAL
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Credential |
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Telephone | 541-523-6745
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | RP0002658
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License Number State | OR
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