Imansjah, Shinta

Imansjah, Shinta is an individual health care provider with primary practice located at 12360 E Burnside St , Portland OR 97233-1042. She recently has only one registered license in Pharmacy Service Providers / Pharmacist, which is considered as her primary health care specialty. Imansjah, Shinta can be contacted via phone (971) 279-4800.

Contact Information

Primary practice address
12360 E Burnside St Portland OR 97233-1042
Phone: (971) 279-4800
Fax: (971) 279-2763
Website:
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Health care specialties

SpecialtyCodeLicense #State
Pharmacy Service Providers / Pharmacist 183500000X PS 40904 Florida
Pharmacy Service Providers / Pharmacist 183500000X RPH-0015242 Oregon

Profile Details

NPI number 1457314353
LBN Legal business name Imansjah, Shinta
Credentials PHARM D/RPH
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 11th, 2006
Last updated Jun 2nd, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1457314353 NPPES
Oregon MEDICAID 500722920

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