Provider Demographics
NPI:1588178933
Name:VIELMA, CASSANDRA VALLEJO (PHARMD STUDENT)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:VALLEJO
Last Name:VIELMA
Suffix:
Gender:F
Credentials:PHARMD STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30399 SW THOMAS ST UNIT 2506
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-6645
Mailing Address - Country:US
Mailing Address - Phone:541-212-3834
Mailing Address - Fax:
Practice Address - Street 1:30399 SW THOMAS ST UNIT 2506
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-6645
Practice Address - Country:US
Practice Address - Phone:541-212-3834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-21
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPI0012691183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist