Provider Demographics
NPI:1811391253
Name:ISHIDA, TINA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:
Last Name:ISHIDA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4665 BUSINESS CENTER DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-1675
Mailing Address - Country:US
Mailing Address - Phone:707-419-7908
Mailing Address - Fax:707-863-4330
Practice Address - Street 1:4665 BUSINESS CENTER DR
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-1675
Practice Address - Country:US
Practice Address - Phone:707-419-7908
Practice Address - Fax:707-863-4330
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-14
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH389631835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist