Provider Demographics
NPI:1164633046
Name:SHIMODA, MATTHEW GEORGE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:GEORGE
Last Name:SHIMODA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1079 HUNTFIELD RD
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-8119
Mailing Address - Country:US
Mailing Address - Phone:410-876-9046
Mailing Address - Fax:
Practice Address - Street 1:1079 HUNTFIELD RD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-8119
Practice Address - Country:US
Practice Address - Phone:410-876-9046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10311183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist