Provider Demographics
NPI:1659640449
Name:FEWX, CAITLIN ADELE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CAITLIN
Middle Name:ADELE
Last Name:FEWX
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:CAITLIN
Other - Middle Name:
Other - Last Name:FEWX-PATRICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:157 NE JAMES ST
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-2420
Mailing Address - Country:US
Mailing Address - Phone:360-721-9066
Mailing Address - Fax:
Practice Address - Street 1:150 LIBERTY ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3506
Practice Address - Country:US
Practice Address - Phone:503-364-3336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0011098183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORRPH-0011098OtherQUISENBERRY PHARMACY, SALEM, OREGON
ORRPH-0011098Medicaid
ORRPH-0011098Medicare PIN
ORRPH-0011098OtherQUISENBERRY PHARMACY, SALEM, OREGON