Provider Demographics
NPI:1558489963
Name:HUDGINS, CORYNA MICHELLE (RPH)
Entity Type:Individual
Prefix:MS
First Name:CORYNA
Middle Name:MICHELLE
Last Name:HUDGINS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5364 WILLOW LEAF ST N
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-7528
Mailing Address - Country:US
Mailing Address - Phone:503-390-8749
Mailing Address - Fax:
Practice Address - Street 1:5452 RIVER RD N
Practice Address - Street 2:RITEAID PHARMACY
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-4429
Practice Address - Country:US
Practice Address - Phone:503-393-8950
Practice Address - Fax:503-390-7838
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR8592183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist