MEDICARE: MS. CORYNA MICHELLE HUDGINS RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	8592	OR

General Provider Information

NPI Number	:	1558489963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CORYNA MICHELLE HUDGINS RPH

Provider Business Mailing Address
First Line	:	5364 WILLOW LEAF ST N
Second Line	:
City	:	KEIZER
State	:	OR
Zip	:	97303-7528
Country	:	US
Telephone Number	:	503-390-8749
Fax Number	:

Provider Business Practice Location Address
First Line	:	5452 RIVER RD N
Second Line	:	RITEAID PHARMACY
City	:	KEIZER
State	:	OR
Zip	:	97303-4429
Country	:	US
Telephone Number	:	503-393-8950
Fax Number	:	503-390-7838

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	07/08/2007

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