Imansjah, Shinta
Imansjah, Shinta is an individual health care provider with primary practice located at 12360 E Burnside St , Portland OR 97233-1042. She recently has only one registered license in Pharmacy Service Providers / Pharmacist, which is considered as her primary health care specialty. Imansjah, Shinta can be contacted via phone (971) 279-4800.Contact Information
Primary practice address
12360 E Burnside St
Portland OR 97233-1042
Phone: (971) 279-4800
Fax: (971) 279-2763
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Pharmacy Service Providers / Pharmacist | 183500000X | PS 40904 | Florida |
| Pharmacy Service Providers / Pharmacist | 183500000X | RPH-0015242 | Oregon |
Profile Details
| NPI number | 1457314353 |
|---|---|
| LBN Legal business name | Imansjah, Shinta |
| Credentials | PHARM D/RPH |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 11th, 2006 |
| Last updated | Jun 2nd, 2023 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1457314353 | NPPES |
| Oregon | MEDICAID | 500722920 |
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