Individual
KELLY WOLDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPH
Contact information
Practice address
13939 SW PACIFIC HWY, TIGARD, OR 97223-4838
(503) 670-9812
Mailing address
13939 SW PACIFIC HWY, TIGARD, OR 97223-4838
(503) 670-9812
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
0011291
OR
Other
Enumeration date
08/24/2009
Last updated
08/24/2009
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