Provider Demographics
NPI:1356742282
Name:WETHERBY, KAREN
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:WETHERBY
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 NW OAK TREE LN
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-1694
Mailing Address - Country:US
Mailing Address - Phone:541-923-6575
Mailing Address - Fax:
Practice Address - Street 1:300 NW OAK TREE LN
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-1694
Practice Address - Country:US
Practice Address - Phone:541-923-6575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0008599183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist