Provider Demographics
NPI:1558695700
Name:CHRISTIANSON, LOREN (PHARMD, BCPS)
Entity Type:Individual
Prefix:
First Name:LOREN
Middle Name:
Last Name:CHRISTIANSON
Suffix:
Gender:M
Credentials:PHARMD, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 INTERNATIONAL WAY
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-1034
Mailing Address - Country:US
Mailing Address - Phone:541-225-1910
Mailing Address - Fax:
Practice Address - Street 1:110 INTERNATIONAL WAY
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-1034
Practice Address - Country:US
Practice Address - Phone:541-225-1910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-21
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10639183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist