Provider Demographics
NPI:1851686661
Name:WATANABE, KRISTEN LW (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:LW
Last Name:WATANABE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21365 SW BALER WAY
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-8989
Mailing Address - Country:US
Mailing Address - Phone:503-610-6001
Mailing Address - Fax:503-610-6001
Practice Address - Street 1:21365 SW BALER WAY
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140-8989
Practice Address - Country:US
Practice Address - Phone:503-610-6001
Practice Address - Fax:503-610-6001
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0011233183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist