Provider Demographics
NPI:1003580739
Name:SHIMODA, KRISTEN ASAKO (PHARMD)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:ASAKO
Last Name:SHIMODA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 ROBLE RD APT 302
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-7543
Mailing Address - Country:US
Mailing Address - Phone:559-593-6730
Mailing Address - Fax:
Practice Address - Street 1:200 MUIR ROAD
Practice Address - Street 2:CLINICAL PHARMACY, HACIENDA BUILDING
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553
Practice Address - Country:US
Practice Address - Phone:559-593-6730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA846911835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist