Provider Demographics
NPI:1093397119
Name:LIN, JUSTIN JOE
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:JOE
Last Name:LIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26468 CARL BOYER DR
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91350-2995
Mailing Address - Country:US
Mailing Address - Phone:661-222-7568
Mailing Address - Fax:661-284-1506
Practice Address - Street 1:26468 CARL BOYER DR
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91350-2995
Practice Address - Country:US
Practice Address - Phone:661-222-7568
Practice Address - Fax:661-284-1506
Is Sole Proprietor?:No
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist