MEDICARE: DR. TAKESHI SHIKUMA PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RPH-0013811	OR

General Provider Information

NPI Number	:	1932536406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TAKESHI SHIKUMA PHARMD

Provider Business Mailing Address
First Line	:	3667 INLAND CT APT 1
Second Line	:
City	:	NORTH BEND
State	:	OR
Zip	:	97459-1257
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3411 BROADWAY AVE
Second Line	:
City	:	NORTH BEND
State	:	OR
Zip	:	97459-1201
Country	:	US
Telephone Number	:	541-756-0118
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2013
Last Update Date	:	09/30/2013

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