Provider Demographics
NPI:1851887970
Name:CARPENTER, SIERRA LYNNE
Entity Type:Individual
Prefix:
First Name:SIERRA
Middle Name:LYNNE
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 BOULDER FALLS DR APT A103
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OR
Mailing Address - Zip Code:97355-2882
Mailing Address - Country:US
Mailing Address - Phone:818-317-0434
Mailing Address - Fax:
Practice Address - Street 1:108 SW MEMORIAL PL
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97331-8667
Practice Address - Country:US
Practice Address - Phone:541-737-3491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-02
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPI-0012205183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist