Provider Demographics
NPI:1386018794
Name:STONEBACK, CHRISTIE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIE
Middle Name:
Last Name:STONEBACK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:CHRISTIE
Other - Middle Name:
Other - Last Name:WYATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:16300 SE EVELYN ST
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-9515
Mailing Address - Country:US
Mailing Address - Phone:503-305-9799
Mailing Address - Fax:623-869-1521
Practice Address - Street 1:16300 SE EVELYN ST
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-9515
Practice Address - Country:US
Practice Address - Phone:503-305-9799
Practice Address - Fax:623-869-1521
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-23
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0010310183500000X
CA55159183500000X
WAPH00070254183500000X
ORRPH-00103101835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist