Provider Demographics
NPI:1679913917
Name:SHAABAN, GINA LEE
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:LEE
Last Name:SHAABAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1839 MOLALLA AVE
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-4011
Mailing Address - Country:US
Mailing Address - Phone:503-657-1483
Mailing Address - Fax:503-657-1480
Practice Address - Street 1:1839 MOLALLA AVE
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-4011
Practice Address - Country:US
Practice Address - Phone:503-657-1483
Practice Address - Fax:503-657-1480
Is Sole Proprietor?:No
Enumeration Date:2013-07-01
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-00098191835P0018X
OR0009819183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist