MEDICARE: JOANNA SHIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RPH035290	GA

General Provider Information

NPI Number	:	1205456662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANNA SHIN

Provider Business Mailing Address
First Line	:	180 PASSAIC AVE BLDG B
Second Line	:
City	:	FAIRFIELD
State	:	NJ
Zip	:	07004-3516
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4050 WINDER HWY
Second Line	:
City	:	FLOWERY BRANCH
State	:	GA
Zip	:	30542-3021
Country	:	US
Telephone Number	:	770-965-1979
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2020
Last Update Date	:	02/18/2025

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Directions to “ JOANNA SHIN ” Practice Location

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