Provider Demographics
NPI:1699169433
Name:BAKER, JORDAN NICOLE (PHARM D)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:NICOLE
Last Name:BAKER
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2203 SW COURT AVE
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-1896
Mailing Address - Country:US
Mailing Address - Phone:541-966-9971
Mailing Address - Fax:
Practice Address - Street 1:2203 SW COURT AVE
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-1896
Practice Address - Country:US
Practice Address - Phone:541-966-9971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-18
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0014517183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist