Healthcare Provider Details

I. General information

NPI: 1376778985
Provider Name (Legal Business Name): MARIA SHIN PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2009
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ZORN AVE
LOUISVILLE KY
40206-1433
US

IV. Provider business mailing address

4201 COBBLESTONE LN
LA GRANGE KY
40031-7029
US

V. Phone/Fax

Practice location:
  • Phone: 502-287-4773
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number015271
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number015271
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: