Healthcare Provider Details

I. General information

NPI: 1861943417
Provider Name (Legal Business Name): DANA SHIMABUKURO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2016
Last Update Date: 11/11/2021
Certification Date: 11/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67-1125 MAMALAHOA HWY
KAMUELA HI
96743-8496
US

IV. Provider business mailing address

10860 SE OAK ST
MILWAUKIE OR
97222-6694
US

V. Phone/Fax

Practice location:
  • Phone: 808-881-4464
  • Fax:
Mailing address:
  • Phone: 503-652-8058
  • Fax: 503-786-0316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH-0015663
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60673057
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH4239
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: