Provider Demographics
NPI:1124302922
Name:HINTON, KRISTINA LEOKADIA (PHARMD)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:LEOKADIA
Last Name:HINTON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:LEOKADIA
Other - Last Name:URBANSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17979 NW PARK VIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-3474
Mailing Address - Country:US
Mailing Address - Phone:503-330-3811
Mailing Address - Fax:
Practice Address - Street 1:913 NW GARDEN VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-6523
Practice Address - Country:US
Practice Address - Phone:541-440-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0012805183500000X
WAPH 60229153183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist