Provider Demographics
NPI:1285034389
Name:MATSUNOBU, SHANE-ANN SUEHIRO (PHARMD)
Entity Type:Individual
Prefix:
First Name:SHANE-ANN
Middle Name:SUEHIRO
Last Name:MATSUNOBU
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:SHANE-ANN
Other - Middle Name:
Other - Last Name:SUEHIRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:400 S 43RD ST
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5714
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:400 S 43RD ST
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5714
Practice Address - Country:US
Practice Address - Phone:425-228-3440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-26
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60467996183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist