Provider Demographics
NPI:1245963693
Name:WALDRON, KERRI RAVEN (PHARMD)
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:RAVEN
Last Name:WALDRON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3156 NW MORNING GLORY DR
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3466
Mailing Address - Country:US
Mailing Address - Phone:541-977-3393
Mailing Address - Fax:
Practice Address - Street 1:100 MULLINS DR STE A1
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OR
Practice Address - Zip Code:97355-2868
Practice Address - Country:US
Practice Address - Phone:541-766-0200
Practice Address - Fax:541-766-6618
Is Sole Proprietor?:No
Enumeration Date:2022-07-04
Last Update Date:2022-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPI-0013372390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program