Provider Demographics
NPI:1336636729
Name:SHIN, YOUNG S (PHARMD)
Entity Type:Individual
Prefix:
First Name:YOUNG
Middle Name:S
Last Name:SHIN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 W TIETAN ST
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-4329
Mailing Address - Country:US
Mailing Address - Phone:509-529-1570
Mailing Address - Fax:509-529-5283
Practice Address - Street 1:633 W TIETAN ST
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-4329
Practice Address - Country:US
Practice Address - Phone:509-529-1570
Practice Address - Fax:509-529-5283
Is Sole Proprietor?:No
Enumeration Date:2018-04-20
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60833929183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist