Healthcare Provider Details

I. General information

NPI: 1477211746
Provider Name (Legal Business Name): JOHNNY LIN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2021
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 SOUND BEACH AVE
OLD GREENWICH CT
06870-1607
US

IV. Provider business mailing address

225 SOUND BEACH AVE
OLD GREENWICH CT
06870-1607
US

V. Phone/Fax

Practice location:
  • Phone: 203-698-1457
  • Fax:
Mailing address:
  • Phone: 203-698-1457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number068791
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPCT.0015838
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: