Basic Information
| Provider Information | |||||||||
| NPI: | 1699983742 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHIMMAN | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | JEAN | ||||||||
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| Credential: | PHARM.D., R.PH. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 940 GRASSER ST | ||||||||
| Address2: | |||||||||
| City: | OREGON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436163133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4196915785 | ||||||||
| FaxNumber: | 4198241778 | ||||||||
| Practice Location | |||||||||
| Address1: | 5300 HARROUN RD | ||||||||
| Address2: | STE #304 | ||||||||
| City: | SYLVANIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435602182 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198241360 | ||||||||
| FaxNumber: | 4198241778 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2007 | ||||||||
| LastUpdateDate: | 07/19/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 03-3-26654 | OH | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.