Provider Demographics
NPI:1174899850
Name:SHIMEK, KRISTEY (RPH)
Entity type:Individual
Prefix:
First Name:KRISTEY
Middle Name:
Last Name:SHIMEK
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 1:3450 COMMERCIAL STREET SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4635
Mailing Address - Country:US
Mailing Address - Phone:503-585-3533
Mailing Address - Fax:503-585-3541
Practice Address - Street 1:3450 COMMERCIAL STREET SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4635
Practice Address - Country:US
Practice Address - Phone:503-585-3533
Practice Address - Fax:503-585-3541
Is Sole Proprietor?:No
Enumeration Date:2012-03-28
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-00079581835P0018X
WAPH000113291835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist