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General NPI Number Information
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NPI Number | 1821137118
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Entity Type | Organization
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Legal Business Name | BOONAM SHIN
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 05/27/2011
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Provider Practice Location Address
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Address Line | 111 W BEVERLY BLVD STE B
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City | MONTEBELLO
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State | CA
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Zip | 90640-4312
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Country | US
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Telephone | 323-724-8111
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Fax | 323-724-1754
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Provider Business Mailing Address
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Address Line | 111 W BEVERLY BLVD STE B
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City | MONTEBELLO
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State | CA
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Zip | 90640-4312
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Country | US
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Telephone | 323-724-8111
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Fax | 323-724-1754
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Authorized Official
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Title or Position | OWNER
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Name | BOONAM SHIN
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Credential | RPH
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Telephone | 323-742-8111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY41023
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License Number State | CA
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