Boonam Shin

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY41023 Issued in CA

Legal business name

BOONAM SHIN

Doing business as

111 Pharmacy

Practice address

111 W Beverly Blvd
Ste B
Montebello, CA 90640-4312

Phone

(323) 724-8111

Fax

(323) 724-1754

NPI assigned

Feb 5, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Boonam Shin, RPH

Title

Owner

Phone

(323) 742-8111

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• 111 PHARMACY Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1306454400000",
    "number": "1821137118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 W BEVERLY BLVD",
            "address_2": "STE B",
            "city": "MONTEBELLO",
            "state": "CA",
            "postal_code": "906404312",
            "telephone_number": "323-724-8111",
            "fax_number": "323-724-1754"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 W BEVERLY BLVD",
            "address_2": "STE B",
            "city": "MONTEBELLO",
            "state": "CA",
            "postal_code": "906404312",
            "telephone_number": "323-724-8111",
            "fax_number": "323-724-1754"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOONAM SHIN",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-05",
        "last_updated": "2011-05-27",
        "status": "A",
        "authorized_official_last_name": "SHIN",
        "authorized_official_first_name": "BOONAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "323-742-8111",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY41023",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER",
            "identifier": "0523008",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PHA410230",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "111 PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Montebello, CA
• Providers in Montebello, CA by specialty
• Community/Retail Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.