Provider Demographics
NPI:1790027068
Name:KASHISHIAN, MARK W (RPH)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:W
Last Name:KASHISHIAN
Suffix:
Gender:M
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:PO BOX 700
Mailing Address - Street 2:
Mailing Address - City:ROGUE RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97537-0700
Mailing Address - Country:US
Mailing Address - Phone:541-582-0559
Mailing Address - Fax:541-582-3045
Practice Address - Street 1:506 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ROGUE RIVER
Practice Address - State:OR
Practice Address - Zip Code:97537-9615
Practice Address - Country:US
Practice Address - Phone:541-582-0559
Practice Address - Fax:541-582-3045
Is Sole Proprietor?:No
Enumeration Date:2013-03-25
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0008241183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORRPH-0008241-POtherPHARMACY PRECEPTOR LICENSE
ORRPH-0008241OtherPHARMACIST LICENSE