Provider Demographics
NPI:1205146669
Name:SHIN, DON (RPH)
Entity type:Individual
Prefix:MR
First Name:DON
Middle Name:
Last Name:SHIN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19849 MARILLA ST
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-5621
Mailing Address - Country:US
Mailing Address - Phone:818-576-0470
Mailing Address - Fax:
Practice Address - Street 1:21949 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-1725
Practice Address - Country:US
Practice Address - Phone:818-348-5542
Practice Address - Fax:818-348-4211
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-19
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52719183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist