Healthcare Provider Details

I. General information

NPI: 1679913917
Provider Name (Legal Business Name): GINA LEE SHAABAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2013
Last Update Date: 04/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1839 MOLALLA AVE
OREGON CITY OR
97045-4011
US

IV. Provider business mailing address

1839 MOLALLA AVE
OREGON CITY OR
97045-4011
US

V. Phone/Fax

Practice location:
  • Phone: 503-657-1483
  • Fax: 503-657-1480
Mailing address:
  • Phone: 503-657-1483
  • Fax: 503-657-1480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH-0009819
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0009819
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: