111 Pharmacy

LBN: Boonam Shin
111 Pharmacy is an health care organization with primary practice located at 111 W Beverly Blvd Ste B, Montebello CA 90640-4312. The organization recently has 2 registered licenses in different health care specialties including Suppliers / Pharmacy, Suppliers / Community/Retail Pharmacy. Suppliers / Community/Retail Pharmacy is the primary health care specialty. Boonam Shin can be contacted via phone (323) 724-8111, or through Shin, Boonam via phone (323) 742-8111.

Contact Information

Primary practice address
111 W Beverly Blvd Ste B Montebello CA 90640-4312
Fax: (323) 724-1754
Website:
Authorized official contact:
Name: Shin, Boonam RPH

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Pharmacy 333600000X
Suppliers / Community/Retail Pharmacy 3336C0003X PHY41023 California

Profile Details

NPI number 1821137118
LBN Legal business name Boonam Shin
DBA Doing business as 111 Pharmacy
Authorized official Shin, Boonam RPH
Entity Organization
Organization subpart 1 No
Enumeration date Feb 5th, 2007
Last updated May 27th, 2011 - about 13 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1821137118 NPPES
Other 0523008 OTHER ID NUMBER
MEDICAID PHA410230 OTHER ID NUMBER

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