Provider Demographics
NPI:1356828313
Name:LY, SHIN LEE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SHIN
Middle Name:LEE
Last Name:LY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 RALPH MCGILL BLVD NE UNIT 533
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-1537
Mailing Address - Country:US
Mailing Address - Phone:781-405-5551
Mailing Address - Fax:
Practice Address - Street 1:608 RALPH MCGILL BLVD NE UNIT 533
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-1537
Practice Address - Country:US
Practice Address - Phone:781-405-5551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH0292631835P0018X
MAPH2373831835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist