Healthcare Provider Details

I. General information

NPI: 1851908909
Provider Name (Legal Business Name): CHRISTOPHER EDWARD POKLADNIK RPH, PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2020
Last Update Date: 09/23/2020
Certification Date: 09/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 N SANTIAM HWY
LEBANON OR
97355-4363
US

IV. Provider business mailing address

525 N SANTIAM HWY
LEBANON OR
97355-4363
US

V. Phone/Fax

Practice location:
  • Phone: 541-451-7565
  • Fax: 541-451-7563
Mailing address:
  • Phone: 541-451-7565
  • Fax: 541-451-7563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH-0014837
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH-0014837
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: