Basic Information
| Provider Information | |||||||||
| NPI: | 1447509898 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ISHIKAWA | ||||||||
| FirstName: | REID | ||||||||
| MiddleName: | YOSHINOBU | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARM.D, RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11425 SW BEAVERTON HILLSDALE HWY | ||||||||
| Address2: | |||||||||
| City: | BEAVERTON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970053050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035261833 | ||||||||
| FaxNumber: | 5035261839 | ||||||||
| Practice Location | |||||||||
| Address1: | 11425 SW BEAVERTON HILLSDALE HWY | ||||||||
| Address2: | |||||||||
| City: | BEAVERTON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970053050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035261833 | ||||||||
| FaxNumber: | 5035261839 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2012 | ||||||||
| LastUpdateDate: | 04/25/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | RPH-0013292 | OR | N | Pharmacy Service Providers | Pharmacist | 1835P0018X | 0013292 | OR | Y | Pharmacy Service Providers | Pharmacist | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
ID Information
| ID | Type | State | Issuer | Description | RPH-0013292 | 01 | OR | OREGON BOARD OF PHARMACY | OTHER |