Provider Demographics
NPI:1225699309
Name:NISHIDA, LYNN MARIE (RPH)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:MARIE
Last Name:NISHIDA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11494 SE RIMROCK DR
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-7154
Mailing Address - Country:US
Mailing Address - Phone:971-242-9973
Mailing Address - Fax:
Practice Address - Street 1:11494 SE RIMROCK DR
Practice Address - Street 2:
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-7154
Practice Address - Country:US
Practice Address - Phone:971-242-9973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7580183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR7580OtherCOMMERCIAL