Provider Demographics
NPI:1790940930
Name:SPRINGER, GWENDOLYN BEATRICE (RPH)
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:BEATRICE
Last Name:SPRINGER
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 1:2283 SW 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-1849
Mailing Address - Country:US
Mailing Address - Phone:541-889-2188
Mailing Address - Fax:541-889-2658
Practice Address - Street 1:2283 SW 4TH AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-1849
Practice Address - Country:US
Practice Address - Phone:541-889-2188
Practice Address - Fax:541-889-2658
Is Sole Proprietor?:No
Enumeration Date:2008-07-28
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0009526183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist