Provider Demographics
NPI:1770015695
Name:SHIMIZU, JONATHAN BRADLEY (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:BRADLEY
Last Name:SHIMIZU
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 1:770 E CALAVERAS BLVD
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-5491
Mailing Address - Country:US
Mailing Address - Phone:408-945-2645
Mailing Address - Fax:408-945-2038
Practice Address - Street 1:770 E CALAVERAS BLVD
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-5491
Practice Address - Country:US
Practice Address - Phone:408-945-2645
Practice Address - Fax:408-945-2038
Is Sole Proprietor?:No
Enumeration Date:2017-03-30
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50384183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist