Provider Demographics
NPI:1992104772
Name:BAKER, RHIANNON (DOCTOR OF PHARMACY)
Entity type:Individual
Prefix:DR
First Name:RHIANNON
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:DOCTOR OF PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 W UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:PORTALES
Mailing Address - State:NM
Mailing Address - Zip Code:88130-6667
Mailing Address - Country:US
Mailing Address - Phone:606-682-1507
Mailing Address - Fax:
Practice Address - Street 1:1900 W UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:PORTALES
Practice Address - State:NM
Practice Address - Zip Code:88130-6667
Practice Address - Country:US
Practice Address - Phone:606-682-1507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00008223183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist