Provider Demographics
NPI:1063861318
Name:BARKER, JACK ROY
Entity type:Individual
Prefix:
First Name:JACK
Middle Name:ROY
Last Name:BARKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 MEADOWLARK CT SE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97322-6470
Mailing Address - Country:US
Mailing Address - Phone:805-720-2608
Mailing Address - Fax:
Practice Address - Street 1:3521 NW SAMARITAN DR STE 202
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-4744
Practice Address - Country:US
Practice Address - Phone:541-768-5225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-07
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-00161661835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist