Provider Demographics
NPI:1740768324
Name:STADSTAD, ALANNA MACHELLE (PHARMD, MBA, BA)
Entity Type:Individual
Prefix:
First Name:ALANNA
Middle Name:MACHELLE
Last Name:STADSTAD
Suffix:
Gender:F
Credentials:PHARMD, MBA, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3655 W 13TH AVE APT 319
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-3484
Mailing Address - Country:US
Mailing Address - Phone:701-429-7377
Mailing Address - Fax:
Practice Address - Street 1:57 W 29TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-3242
Practice Address - Country:US
Practice Address - Phone:541-342-7648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-05
Last Update Date:2018-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0016709183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist