Healthcare Provider Details

I. General information

NPI: 1508872433
Provider Name (Legal Business Name): JEFFREY KENT SHINODA PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6121 N THESTA ST STE 204
FRESNO CA
93710-5294
US

IV. Provider business mailing address

6121 N THESTA ST STE 204
FRESNO CA
93710-5294
US

V. Phone/Fax

Practice location:
  • Phone: 559-435-2425
  • Fax: 559-438-4372
Mailing address:
  • Phone: 559-435-2425
  • Fax: 559-438-4372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH41852
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License NumberRPH41852
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: