Provider Demographics
NPI:1003433418
Name:SHIMATA, LIWEN (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:LIWEN
Middle Name:
Last Name:SHIMATA
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:DR
Other - First Name:COLLEEN
Other - Middle Name:
Other - Last Name:LU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:3931 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:WASHOUGAL
Mailing Address - State:WA
Mailing Address - Zip Code:98671-8912
Mailing Address - Country:US
Mailing Address - Phone:503-358-3459
Mailing Address - Fax:
Practice Address - Street 1:9000 N LOMBARD ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97203-3006
Practice Address - Country:US
Practice Address - Phone:503-988-5308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0010532183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0010532OtherOREGON RPH LICENSE