Provider Demographics
NPI:1437764867
Name:WARD, CHRISTOPHER
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:WARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1423 N JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:OR
Mailing Address - Zip Code:97127-9213
Mailing Address - Country:US
Mailing Address - Phone:503-864-4536
Mailing Address - Fax:
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:503-319-8721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORCPT0000064183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician