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General NPI Number Information
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NPI Number | 1649991845
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Entity Type | Individual
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Provider Name | SHAWNTESSA LESTER
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Gender | Female
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Dates
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Enumeration Date | 09/06/2022
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Last Update Date | 09/06/2022
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Provider Practice Location Address
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Address Line | 2103 W BURNSIDE ST
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City | PORTLAND
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State | OR
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Zip | 97210-3519
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Country | US
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Telephone | 503-295-6480
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Fax |
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Provider Business Mailing Address
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Address Line | 1111 W COLUMBIA WAY APT 740
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City | VANCOUVER
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State | WA
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Zip | 98660-3621
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Country | US
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Telephone | 605-430-7621
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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 | 61311154
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 0019065
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License Number State | OR
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