Provider Demographics
NPI:1447509898
Name:ISHIKAWA, REID YOSHINOBU (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:REID
Middle Name:YOSHINOBU
Last Name:ISHIKAWA
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11425 SW BEAVERTON HILLSDALE HWY
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-3050
Mailing Address - Country:US
Mailing Address - Phone:503-526-1833
Mailing Address - Fax:503-526-1839
Practice Address - Street 1:11425 SW BEAVERTON HILLSDALE HWY
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-3050
Practice Address - Country:US
Practice Address - Phone:503-526-1833
Practice Address - Fax:503-526-1839
Is Sole Proprietor?:No
Enumeration Date:2012-08-31
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0013292183500000X
OR00132921835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORRPH-0013292OtherOREGON BOARD OF PHARMACY