Provider Demographics
NPI:1770849135
Name:PEDRO, WINNIE (RPH)
Entity type:Individual
Prefix:MS
First Name:WINNIE
Middle Name:
Last Name:PEDRO
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 1:6850 N LOMBARD ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203-6247
Mailing Address - Country:US
Mailing Address - Phone:503-240-2733
Mailing Address - Fax:503-240-2724
Practice Address - Street 1:6850 N LOMBARD ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97203-6247
Practice Address - Country:US
Practice Address - Phone:503-240-2733
Practice Address - Fax:503-240-2724
Is Sole Proprietor?:No
Enumeration Date:2012-04-10
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0008722183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist