Provider Demographics
NPI:1619776267
Name:BAHSOUS, CHRESTEEN
Entity type:Individual
Prefix:
First Name:CHRESTEEN
Middle Name:
Last Name:BAHSOUS
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 1:1213 NE 190TH PL
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-7550
Mailing Address - Country:US
Mailing Address - Phone:971-331-1861
Mailing Address - Fax:
Practice Address - Street 1:1213 NE 190TH PL
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-7550
Practice Address - Country:US
Practice Address - Phone:971-331-1861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-07
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0020432183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist