Provider Demographics
NPI:1649009531
Name:SANTOS, CHEYENNE CELINE (PHARMD)
Entity type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:CELINE
Last Name:SANTOS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:298 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06604-4623
Mailing Address - Country:US
Mailing Address - Phone:646-245-6506
Mailing Address - Fax:
Practice Address - Street 1:2525 SW 3RD AVE STE 110
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-4901
Practice Address - Country:US
Practice Address - Phone:646-245-6506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-29
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0020497183500000X
OH03444590183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist