Provider Demographics
NPI:1609149673
Name:VAN, CHRISTINA (PHARM D)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:
Last Name:VAN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5253 SE 82ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-4862
Mailing Address - Country:US
Mailing Address - Phone:503-788-2885
Mailing Address - Fax:503-774-6971
Practice Address - Street 1:5253 SE 82ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-4862
Practice Address - Country:US
Practice Address - Phone:503-788-2885
Practice Address - Fax:503-774-6971
Is Sole Proprietor?:No
Enumeration Date:2012-02-21
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0010309183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist