Provider Demographics
NPI:1508872433
Name:SHINODA, JEFFREY KENT (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:KENT
Last Name:SHINODA
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 1:6121 N THESTA ST STE 204
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5294
Mailing Address - Country:US
Mailing Address - Phone:559-435-2425
Mailing Address - Fax:559-438-4372
Practice Address - Street 1:6121 N THESTA ST STE 204
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5294
Practice Address - Country:US
Practice Address - Phone:559-435-2425
Practice Address - Fax:559-438-4372
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH41852183500000X, 1835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835X0200XPharmacy Service ProvidersPharmacistOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALSC99279OtherSTERILE CPD LICENSE-PHARM
CAPHY47019OtherPHARMACY LICENSE
CARPH41852OtherPHARMACIST LICENSE.
CARPH41852OtherPHARMACIST LICENSE.
CABJ9116547OtherDEA-PHARMACY
CABJ9116547OtherDEA-PHARMACY