MEDICARE: MR. WHASUB DAVID SHIM RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	35663	CA

General Provider Information

NPI Number	:	1740505072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WHASUB DAVID SHIM RPH

Provider Business Mailing Address
First Line	:	5818 BELLFLOWER BLVD
Second Line	:
City	:	LAKEWOOD
State	:	CA
Zip	:	90713-1058
Country	:	US
Telephone Number	:	562-866-5795
Fax Number	:	562-866-0257

Provider Business Practice Location Address
First Line	:	5818 BELLFLOWER BLVD
Second Line	:
City	:	LAKEWOOD
State	:	CA
Zip	:	90713-1058
Country	:	US
Telephone Number	:	562-866-5795
Fax Number	:	562-866-0257

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2010
Last Update Date	:	03/30/2010

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