Provider Demographics
NPI:1053712455
Name:OKUDA-EASTON, TINA J
Entity type:Individual
Prefix:MS
First Name:TINA
Middle Name:J
Last Name:OKUDA-EASTON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 Q ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-2353
Mailing Address - Country:US
Mailing Address - Phone:541-741-5183
Mailing Address - Fax:541-741-5180
Practice Address - Street 1:650 Q ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-2353
Practice Address - Country:US
Practice Address - Phone:541-741-5183
Practice Address - Fax:541-741-5180
Is Sole Proprietor?:No
Enumeration Date:2014-09-04
Last Update Date:2025-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH00069931835P0018X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist