Kristine Ethridge, PHARM.D.

Primary specialty

Pharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistTaxonomy code 1835P0018X

License

RPH-0014863 Issued in OR

Practice address

3930 SE Division St
Portland, OR 97202-1643

Phone

(503) 418-3250

Fax

(503) 418-3330

NPI assigned

Aug 19, 2015

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1439942400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740960000000",
    "number": "1477929958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10101 SE MAIN ST STE 1001",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972162456",
            "telephone_number": "503-346-6410",
            "fax_number": "503-346-6360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3930 SE DIVISION ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972021643",
            "telephone_number": "503-418-3250",
            "fax_number": "503-418-3330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETHRIDGE",
        "first_name": "KRISTINE",
        "name_prefix": "Dr.",
        "credential": "PHARM.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-08-19",
        "last_updated": "2025-03-03",
        "certification_date": "2025-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "OR",
            "license": "RPH-0014863",
            "primary": false
        },
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "OR",
            "license": "RPH-0014863",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Portland, OR
• Providers in Portland, OR by specialty
• Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.