Provider Demographics
NPI:1265557318
Name:CUDAHY, CHRISTINA DEBRA (RPH)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:DEBRA
Last Name:CUDAHY
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 1:15685 SW 116TH AVE
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-2651
Mailing Address - Country:US
Mailing Address - Phone:503-639-7377
Mailing Address - Fax:503-620-2167
Practice Address - Street 1:15685 SW 116TH AVE
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-2651
Practice Address - Country:US
Practice Address - Phone:503-639-7377
Practice Address - Fax:503-620-2167
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6889183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist