Provider Demographics
NPI:1700159597
Name:BREITENSTEIN, ELIZABETH (PHARMD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BREITENSTEIN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:LIZ
Other - Middle Name:
Other - Last Name:BREITENSTEIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:800 NE OREGON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2162
Mailing Address - Country:US
Mailing Address - Phone:503-509-8819
Mailing Address - Fax:
Practice Address - Street 1:800 NE OREGON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2162
Practice Address - Country:US
Practice Address - Phone:503-509-8819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-09
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60183739183500000X
OR0012354183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist