Provider Demographics
NPI:1548570195
Name:KRADJAN, WAYNE A (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:A
Last Name:KRADJAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 NW HEATHER DR.
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3009
Mailing Address - Country:US
Mailing Address - Phone:541-757-9693
Mailing Address - Fax:
Practice Address - Street 1:1601 SW JEFFERSON STREET
Practice Address - Street 2:OREGON STATE UNIVERSITY - COLLEGE OF PHARMACY
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97331-3507
Practice Address - Country:US
Practice Address - Phone:541-737-5785
Practice Address - Fax:541-737-3999
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26714183500000X
WA000094051835P0018X
OR00096961835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist