Provider Demographics
NPI:1710653985
Name:HEIM, CRISTINA DANIELLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:DANIELLE
Last Name:HEIM
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 1:13524 SW WILLOW TOP LN
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-0942
Mailing Address - Country:US
Mailing Address - Phone:503-888-4005
Mailing Address - Fax:
Practice Address - Street 1:8235 SW WILSONVILLE RD
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-7718
Practice Address - Country:US
Practice Address - Phone:503-682-2701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0018456183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist