Provider Demographics
NPI:1649362922
Name:GEDEROS, KARIE G (PHARMACY CPHT)
Entity type:Individual
Prefix:
First Name:KARIE
Middle Name:G
Last Name:GEDEROS
Suffix:
Gender:F
Credentials:PHARMACY CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1775 THOMPSON RD
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-2125
Mailing Address - Country:US
Mailing Address - Phone:541-269-8160
Mailing Address - Fax:
Practice Address - Street 1:1370 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-1031
Practice Address - Country:US
Practice Address - Phone:541-267-2014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORCPT-0000947183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORCPT-0000947OtherOREGON BOARD OF PHARMACY