Individual
ROBERT BAKKEGARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
314 S MAIN STREET, CANYONVILLE, OR 97417
(541) 839-4452
Mailing address
PO BOX 1097, CANYONVILLE, OR 97417-1097
(503) 871-1297
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH-0006386
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RPH-0006386
OREGON BOARD OF PHARMACY LICENSE
OR
Enumeration date
04/09/2020
Last updated
04/09/2020
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