Provider Demographics
NPI:1700162849
Name:EDMUNDSON, VICTORIA R (RPH)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:R
Last Name:EDMUNDSON
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 1:215 9TH ST
Mailing Address - Street 2:
Mailing Address - City:BAKER CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97814-4370
Mailing Address - Country:US
Mailing Address - Phone:541-215-0113
Mailing Address - Fax:
Practice Address - Street 1:1205 CAMPBELL ST
Practice Address - Street 2:
Practice Address - City:BAKER CITY
Practice Address - State:OR
Practice Address - Zip Code:97814-2271
Practice Address - Country:US
Practice Address - Phone:541-524-0418
Practice Address - Fax:541-524-0419
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-02
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR71491835P0018X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist