Organization
BOONAM SHIN
Active
Other names
111 PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
BOONAM SHIN RPH (OWNER)
(323) 742-8111
Entity
Organization
Contact information
Practice address
111 W BEVERLY BLVD, STE B, MONTEBELLO, CA 90640-4312
(323) 724-8111
(323) 724-1754
Mailing address
111 W BEVERLY BLVD, STE B, MONTEBELLO, CA 90640-4312
(323) 724-8111
(323) 724-1754
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY41023
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0523008
OTHER ID NUMBER
—
05
—
PHA410230
—
CA
Enumeration date
02/05/2007
Last updated
05/27/2011
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