Healthcare Provider Details

I. General information

NPI: 1801316013
Provider Name (Legal Business Name): KRISTEN DERYN ANGERSTIEN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2017
Last Update Date: 06/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2870 NE WEST DEVILS LAKE RD
LINCOLN CITY OR
97367-5127
US

IV. Provider business mailing address

1554 SE PORT DR
LINCOLN CITY OR
97367-2607
US

V. Phone/Fax

Practice location:
  • Phone: 541-996-7296
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH-0014101
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: