Healthcare Provider Details

I. General information

NPI: 1013840891
Provider Name (Legal Business Name): KRISTINA MELODY LASSFOLK BETTENCOURT PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTINA MELODY LASSFOLK

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 GRANTS PASS PKWY
GRANTS PASS OR
97526-2359
US

IV. Provider business mailing address

1101 GRANTS PASS PKWY
GRANTS PASS OR
97526-2359
US

V. Phone/Fax

Practice location:
  • Phone: 541-474-7234
  • Fax: 541-474-7240
Mailing address:
  • Phone: 541-474-7234
  • Fax: 541-474-7240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0014938
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: