Provider Demographics
NPI:1003118233
Name:BLEZINSKI, KATHERINE EVA (RPH)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:EVA
Last Name:BLEZINSKI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17779 LOWER BOONES FERRY RD
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-5237
Mailing Address - Country:US
Mailing Address - Phone:503-675-2509
Mailing Address - Fax:503-675-2512
Practice Address - Street 1:17779 LOWER BOONES FERRY RD
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-5237
Practice Address - Country:US
Practice Address - Phone:503-675-2509
Practice Address - Fax:503-675-2512
Is Sole Proprietor?:No
Enumeration Date:2010-11-19
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7863183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist