Provider Demographics
NPI:1508142399
Name:OKSENDAHL, KELLI LYNN (PHARMD)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:LYNN
Last Name:OKSENDAHL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:LYNN
Other - Last Name:BERGSTROM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:3130 SIMPSON AVE
Mailing Address - Street 2:
Mailing Address - City:HOQUIAM
Mailing Address - State:WA
Mailing Address - Zip Code:98550-3027
Mailing Address - Country:US
Mailing Address - Phone:360-533-5531
Mailing Address - Fax:
Practice Address - Street 1:3130 SIMPSON AVE
Practice Address - Street 2:
Practice Address - City:HOQUIAM
Practice Address - State:WA
Practice Address - Zip Code:98550-3027
Practice Address - Country:US
Practice Address - Phone:360-533-5531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60236109183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist