Provider Demographics
NPI:1417644147
Name:CHRISTENSEN, JOHN MARK (PHARMACIST)
Entity Type:Individual
Prefix:PROF
First Name:JOHN
Middle Name:MARK
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1592 NW TERRACEGREEN PL
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-1347
Mailing Address - Country:US
Mailing Address - Phone:541-752-6421
Mailing Address - Fax:
Practice Address - Street 1:1592 NW TERRACEGREEN PL
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-1347
Practice Address - Country:US
Practice Address - Phone:541-752-6421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0006966183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist