Provider Demographics
NPI:1720388036
Name:SPIESS, CHARLENE RENEE (RPH)
Entity Type:Individual
Prefix:MR
First Name:CHARLENE
Middle Name:RENEE
Last Name:SPIESS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37601 HIGHWAY 26
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:OR
Mailing Address - Zip Code:97055-9313
Mailing Address - Country:US
Mailing Address - Phone:503-668-2336
Mailing Address - Fax:503-668-2339
Practice Address - Street 1:37601 HIGHWAY 26
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:OR
Practice Address - Zip Code:97055-9313
Practice Address - Country:US
Practice Address - Phone:503-668-2336
Practice Address - Fax:503-668-2339
Is Sole Proprietor?:No
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR8042183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist