SHINTA IMANSJAH (NPI# 1457314353) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457314353 |
| Entity Type | Individual |
| Full Name | SHINTA IMANSJAH |
| Credential | PHARM D/RPH |
| Practice Address |
12360 E Burnside St Portland OR 97233-1042 |
| Mailing Address |
1776 Sw Madison St Portland OR 97205-1715 |
| Practice Telephone | 9712794800 |
| Practice Fax Number | 9712792763 |
| Mailing Telephone | 9713862278 |
| Mailing Fax Number | 5032244494 |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2019-02-07 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 183500000X | Pharmacist | RP00007233 | NM | Pharmacy Service Providers |
| Y | 183500000X | Pharmacist | RPH-0015242 | OR | Pharmacy Service Providers |
| N | 183500000X | Pharmacist | PS 40904 | FL | Pharmacy Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 500722920 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 15 N Morris St, Portland, OR 972271541 | 5032309875 | 5032309877 |
| Street Address |
12360 E BURNSIDE ST |
| City | PORTLAND |
| State | OR |
| Zip Code | 97233-1042 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508856188 | Artice E Geary | Social Worker | 12360 E Burnside St, Portland, OR 97233-1042 | 2005-10-25 |
| 1487262937 | Erica P Woody | Counselor | 12360 E Burnside St, Portland, OR 97233-1042 | 2020-07-21 |
| 1609416155 | Cara A Koch | Counselor | 12360 E Burnside St, Portland, OR 97233-1042 | 2020-01-13 |
| 1245878552 | Janelle M Bombara | Dietitian, Registered | 12360 E Burnside St, Portland, OR 97233-1042 | 2019-12-17 |
| 1932756707 | Holly A Fay | Registered Nurse | 12360 E Burnside St, Portland, OR 97233-1042 | 2019-08-26 |
| 1013570548 | Christa R Andreasen | Registered Nurse | 12360 E Burnside St, Portland, OR 97233-1042 | 2019-04-19 |
| 1679046965 | Emerson N Begay | Pharmacy Technician | 12360 E Burnside St, Portland, OR 97233-1042 | 2019-01-09 |
| 1215429394 | Phillip C Lacy | Pharmacy Technician | 12360 E Burnside St, Portland, OR 97233-1042 | 2018-06-04 |
| 1992205223 | Sarah E Bruno | Social Worker | 12360 E Burnside St, Portland, OR 97233-1042 | 2018-02-13 |
| 1093233868 | Sarah S Rivera | Peer Specialist | 12360 E Burnside St, Portland, OR 97233-1042 | 2017-08-31 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205448164 | Moore Therapy Services, LLC | Behavioral Analyst | 2053 Se 181st Ave, Portland, OR 97233 | 2020-08-20 |
| 1427563733 | Central City Concern Inc | Clinic/Center | 1415 Se 122nd Ave, Portland, OR 97233 | 2017-12-08 |
| 1427573443 | Sunshine Ahc | In Home Supportive Care | 2217 Se 156th Ave, Portland, OR 97233 | 2017-08-10 |
| 1538609433 | Nathaniel Davis Jr. | Counselor | 8915 Se Center St, Tigard, OR 97233 | 2017-02-27 |
| 1154878627 | Oregon Outreach Inc | Case Management | 1740 South East 139th Avenue, Portland, OR 97233 | 2016-09-01 |
| 1023461019 | Julianne Baltzley | Counselor | 2409 Se 149th Avenue, Portland, OR 97233 | 2016-07-14 |
| 1710332143 | Emma Slater | Counselor | 12360 Se Burnside, Portland, OR 97233 | 2016-05-04 |
| 1245621952 | Gregory Brett Bledsoe | Counselor | 1427 Se 182nd Ave., Portland, OR 97233 | 2015-02-17 |
| 1396149852 | Jacqueline Bension | Counselor | 1705 Se 122nd Ave, Portland, OR 97233 | 2014-10-13 |
| 1700206950 | Olga I Zlatova I | Dental Hygienist | 325 Se 154th Ave, Portland, OR 97233 | 2014-04-25 |
| Find all providers in zip 97233 | ||||
| Taxonomy Code | 183500000X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care. |
| Notes: Source: Adapted from National Association of Boards of Pharmacy Model State Pharmacy Act, Article 1, Section 104. [1/1/2006: definition modified, source modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407460371 | Samantha Nozomi Murata | Pharmacist | 5415 Sw Beaverton Ct Hwy, Portland, OR 97221 | 2020-09-08 |
| 1053923920 | Hoang Lan Ngoc Doan | Pharmacist | 4201 Ne 129th Pl, Portland, OR 97230-1405 | 2020-08-20 |
| 1528677531 | Mi Pham | Pharmacist | 5824 Se 134th Pl, Portland, OR 97236-2987 | 2020-07-26 |
| 1700407350 | Emad Banoub | Pharmacist | 1105 Hyw 181, Portland, TX 78374 | 2020-05-05 |
| 1255951471 | Nam Lai | Pharmacist | 2655 Se 50th Ave Apt 415, Portland, OR 97206-1577 | 2020-04-17 |
| 1275167439 | Mayasah Anas Sedeeq Al Bazzaz | Pharmacist | 15122 Nw Fig Ln, Portland, OR 97229-6986 | 2020-02-26 |
| 1427696632 | Thai Tran | Pharmacist | 7901 Se Powell Blvd, Portland, OR 97206-2314 | 2019-12-18 |
| 1740825587 | Dalia Bayaa | Pharmacist | 325 Sw Harrison Street, Portland, OR 97201 | 2019-11-15 |
| 1225687981 | Pheba Mariam Jones | Pharmacist | Ohsu Pharmacy At Chh Building 2, 3303 Sw Bond Ave Rm 1090, Portland, OR 97239 | 2019-09-05 |
| 1952966970 | Linda P. Pham | Pharmacist | 7901 Se Powell Blvd Ste K, Portland, OR 97206-2314 | 2019-05-06 |
| Find all providers in PORTLAND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.