Provider Demographics
NPI:1487331278
Name:PEDERSON, ELINA GOUW (RPH)
Entity type:Individual
Prefix:
First Name:ELINA
Middle Name:GOUW
Last Name:PEDERSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33624 SPRINGER RD
Mailing Address - Street 2:
Mailing Address - City:PHILOMATH
Mailing Address - State:OR
Mailing Address - Zip Code:97370-9718
Mailing Address - Country:US
Mailing Address - Phone:503-484-7048
Mailing Address - Fax:
Practice Address - Street 1:2500 SANTIAM HWY SE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97322-5265
Practice Address - Country:US
Practice Address - Phone:541-967-6730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-03
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0020256183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist