Healthcare Provider Details

I. General information

NPI: 1609119866
Provider Name (Legal Business Name): RENSHUAY JUSTIN SHIH PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2013
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 CAMPUS POINT DR
LA JOLLA CA
92037-1300
US

IV. Provider business mailing address

10735 PASSERINE WAY
SAN DIEGO CA
92121-4216
US

V. Phone/Fax

Practice location:
  • Phone: 858-249-6181
  • Fax:
Mailing address:
  • Phone: 858-405-8310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number69558
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: