Provider Demographics
NPI:1013199165
Name:CHINWUBA, HEIDI L (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:L
Last Name:CHINWUBA
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 1:4400 NE HALSEY ST
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-1545
Mailing Address - Country:US
Mailing Address - Phone:503-893-6900
Mailing Address - Fax:
Practice Address - Street 1:4400 NE HALSEY ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-1545
Practice Address - Country:US
Practice Address - Phone:503-893-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-30
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-00106191835P1200X
WAPH000707741835P1200X
MTRPH 50701835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy