Provider Demographics
NPI:1467829051
Name:HAN, SHIN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SHIN
Middle Name:
Last Name:HAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:SHIN
Other - Middle Name:
Other - Last Name:HAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD RPH
Mailing Address - Street 1:1 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-2811
Mailing Address - Country:US
Mailing Address - Phone:978-774-7130
Mailing Address - Fax:
Practice Address - Street 1:1 MAPLE ST
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-2811
Practice Address - Country:US
Practice Address - Phone:978-774-7130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-31
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03729100183500000X
MAPH237381183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist