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General NPI Number Information
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NPI Number | 1588728265
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Entity Type | Individual
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Provider Name | LILLY FONG SHIMABUKURO PHARM.D
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Gender | Female
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1011 BALDWIN PARK BLVD
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City | BALDWIN PARK
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State | CA
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Zip | 91706-5806
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Country | US
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Telephone | 626-851-7001
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Fax |
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Provider Business Mailing Address
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Address Line | 3979 HUMBOLDT DR
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92649-2158
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Country | US
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Telephone | 714-846-6585
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH 43603
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License Number State | CA
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