Individual
TIM RICHARD CRISWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CPHT
Contact information
Practice address
600 NE 8TH ST, GRESHAM, OR 97030-7317
(503) 988-5154
(503) 988-5509
Mailing address
979 NE HOOD AVE, GRESHAM, OR 97030-5616
(503) 575-8185
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
CPT-0001684
OR
Other
Enumeration date
06/29/2020
Last updated
10/17/2023
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