Provider Demographics
NPI:1629289004
Name:SIM, SHINYOUNG (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:SHINYOUNG
Middle Name:
Last Name:SIM
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2412 N PONDEROSA DR STE B106
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-2474
Mailing Address - Country:US
Mailing Address - Phone:805-388-5888
Mailing Address - Fax:805-388-5889
Practice Address - Street 1:2412 N PONDEROSA DR STE B106
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-2474
Practice Address - Country:US
Practice Address - Phone:805-388-5888
Practice Address - Fax:805-388-5889
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50247183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist