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General NPI Number Information
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NPI Number | 1750866299
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Entity Type | Individual
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Provider Name | SEOK YOUN SHIN
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Gender | Male
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Dates
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Enumeration Date | 10/01/2018
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Last Update Date | 10/01/2018
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Provider Practice Location Address
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Address Line | 7700 LITTLE RIVER TPKE STE 103
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City | ANNANDALE
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State | VA
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Zip | 22003-2400
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Country | US
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Telephone | 571-334-4513
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Fax |
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Provider Business Mailing Address
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Address Line | 5124 RED FOX DR
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City | ANNANDALE
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State | VA
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Zip | 22003-4138
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 0202208706
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License Number State | VA
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