Healthcare Provider Details

I. General information

NPI: 1144408709
Provider Name (Legal Business Name): INSOON SHIN R.PH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2008
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3632 UNION ST
FLUSHING NY
11354-4287
US

IV. Provider business mailing address

3632 UNION ST
FLUSHING NY
11354-4287
US

V. Phone/Fax

Practice location:
  • Phone: 718-961-6010
  • Fax: 718-358-9221
Mailing address:
  • Phone: 718-961-6010
  • Fax: 718-358-9221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051244
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: