Provider Demographics
NPI:1063453397
Name:ACCOLA, CHRISTOPHER LEE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:LEE
Last Name:ACCOLA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:MR
Other - First Name:CHRISTOPHER
Other - Middle Name:LEE
Other - Last Name:ACCOLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:1210 MOHAWK BLVD
Mailing Address - Street 2:WALGREENS
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477
Mailing Address - Country:US
Mailing Address - Phone:541-747-3619
Mailing Address - Fax:
Practice Address - Street 1:1210 MOHAWK BLVD
Practice Address - Street 2:WALGREENS
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477
Practice Address - Country:US
Practice Address - Phone:541-747-3619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01181363A00000X
ORRPH-0011767183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA16459Medicare ID - Type Unspecified
P01095Medicare UPIN