Provider Demographics
NPI:1134720493
Name:SHIN, VLADIMIR (PHARMD)
Entity type:Individual
Prefix:
First Name:VLADIMIR
Middle Name:
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 1:9906 67TH RD APT 2D
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3078
Mailing Address - Country:US
Mailing Address - Phone:718-300-4090
Mailing Address - Fax:
Practice Address - Street 1:725 SAW MILL RIVER RD
Practice Address - Street 2:
Practice Address - City:ARDSLEY
Practice Address - State:NY
Practice Address - Zip Code:10502-1811
Practice Address - Country:US
Practice Address - Phone:914-693-9191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY067224183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist