=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336125749
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAROL TAMI SHINBO R.PH.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/16/2005
-----------------------------------------------------
Last Update Date | 09/24/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12303 NE 130TH LN SUITE 210
-----------------------------------------------------
City | KIRKLAND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98034-3099
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-899-2790
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6748 SE 25TH ST
-----------------------------------------------------
City | MERCER ISLAND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98040-2500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-236-2525
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PH00009322
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------