Provider Demographics
NPI:1558078873
Name:PUCKETT, ALEXANDRA (PHARMD)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:PUCKETT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 N HWY 20
Mailing Address - Street 2:
Mailing Address - City:HINES
Mailing Address - State:OR
Mailing Address - Zip Code:97738-9435
Mailing Address - Country:US
Mailing Address - Phone:541-573-1523
Mailing Address - Fax:541-573-1502
Practice Address - Street 1:629 N HWY 20
Practice Address - Street 2:
Practice Address - City:HINES
Practice Address - State:OR
Practice Address - Zip Code:97738-9435
Practice Address - Country:US
Practice Address - Phone:541-573-1523
Practice Address - Fax:541-573-1502
Is Sole Proprietor?:No
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0019262183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist