Provider Demographics
NPI:1174128573
Name:KAMESHIGE, JANETTE (RPH)
Entity type:Individual
Prefix:
First Name:JANETTE
Middle Name:
Last Name:KAMESHIGE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 ONION AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-8808
Mailing Address - Country:US
Mailing Address - Phone:208-739-1312
Mailing Address - Fax:
Practice Address - Street 1:1620 N WHITLEY DR
Practice Address - Street 2:
Practice Address - City:FRUITLAND
Practice Address - State:ID
Practice Address - Zip Code:83619-2129
Practice Address - Country:US
Practice Address - Phone:208-452-7075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP6061183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist