Provider Demographics
NPI:1699066936
Name:BADENHORST, CATO JEANETTE (RPH)
Entity type:Individual
Prefix:
First Name:CATO
Middle Name:JEANETTE
Last Name:BADENHORST
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 1:888 VERMONT ST
Mailing Address - Street 2:APT 2C
Mailing Address - City:NORTH BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97459-3334
Mailing Address - Country:US
Mailing Address - Phone:541-756-6713
Mailing Address - Fax:
Practice Address - Street 1:2040 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:OR
Practice Address - Zip Code:97459-2328
Practice Address - Country:US
Practice Address - Phone:541-756-7531
Practice Address - Fax:541-756-4136
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0011753183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist