Provider Demographics
NPI:1568865145
Name:PETRAITIS, CASSANDRA (PHARMD)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:PETRAITIS
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 1:9586 LOGAN RD
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-9314
Mailing Address - Country:US
Mailing Address - Phone:530-510-1483
Mailing Address - Fax:
Practice Address - Street 1:600 NW 10TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-3202
Practice Address - Country:US
Practice Address - Phone:503-227-4835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-26
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0014386183500000X, 1835P0018X
CA71775183500000X
COPHA.0020749183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist