Robert Bakkegard, RPH
Individual provider Active NPI Pharmacist · Canyonville, OR
NPI 1407475577 · NPPES record last updated Apr 9, 2020
Key facts
- NPI
- 1407475577
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- RPH-0006386 (OR)
- Practice address
- 314 S Main Street
Canyonville, OR 97417 - Phone
- (541) 839-4452
- NPI assigned
- Apr 9, 2020
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RPH-0006386 | OR | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gordons Pharmacy & Gifts LLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RPH-0006386 | OR | Yes |
Addresses
Primary practice location
314 S Main Street
Canyonville, OR 97417
Mailing address
PO Box 1097
Canyonville, OR 97417-1097
Phone (503) 871-1297
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| RPH-0006386 | Other | OR | OREGON BOARD OF PHARMACY LICENSE |
Other providers in Canyonville, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 9, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.