Active NPI
Shannon Kim
- Pharmacist
- Glendale, NY
National Provider Identifier
1710556410
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 064616
- Practice address
- 6802 Myrtle Ave
Glendale, NY 11385-7235 - Phone
- (718) 456-1180
- NPI assigned
- Jun 18, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 064616 | NY | Primary |
Addresses
Primary practice location
6802 Myrtle Ave
Glendale, NY 11385-7235
Mailing address
3 Lynhaven PL
South Setauket, NY 11720-1213
Phone (631) 449-0234
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 064616 | NY | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| CVS Albany LLC | Current | Accepting new patients |
Locations
6802 Myrtle Ave
Glendale, NY 11385
Phone (718) 456-1165
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1623974400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1623974400000",
"number": "1710556410",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3 LYNHAVEN PL",
"city": "SOUTH SETAUKET",
"state": "NY",
"postal_code": "117201213",
"telephone_number": "631-449-0234"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6802 MYRTLE AVE",
"city": "GLENDALE",
"state": "NY",
"postal_code": "113857235",
"telephone_number": "718-456-1180"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "SHANNON",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-06-18",
"last_updated": "2021-06-18",
"certification_date": "2021-06-18",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "064616",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glendale, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.