Provider Demographics
NPI:1568862829
Name:RENZEMA, CHRISTINA MARIE (PHARMD, RPH)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:MARIE
Last Name:RENZEMA
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:MS
Other - First Name:CHRISTINA
Other - Middle Name:MARIE
Other - Last Name:WARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3307 SE EVERGREEN BLDG 5
Mailing Address - Street 2:SAFEWAY PHARMACY #1687
Mailing Address - City:WASHOUGAL
Mailing Address - State:WA
Mailing Address - Zip Code:98671
Mailing Address - Country:US
Mailing Address - Phone:360-335-2006
Mailing Address - Fax:360-335-2008
Practice Address - Street 1:3307 SE EVERGREEN BLDG 5
Practice Address - Street 2:SAFEWAY PHARMACY #1687
Practice Address - City:WASHOUGAL
Practice Address - State:WA
Practice Address - Zip Code:98671
Practice Address - Country:US
Practice Address - Phone:360-335-2006
Practice Address - Fax:360-335-2008
Is Sole Proprietor?:No
Enumeration Date:2014-08-23
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPI0010963183500000X
ORRPH-0014373183500000X
WAPH60496163183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist