Provider Demographics
NPI:1861101388
Name:SHIN, HEESOO (PHARMD)
Entity type:Individual
Prefix:
First Name:HEESOO
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 1:2000 CRAWFORD ST STE 105
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-9071
Mailing Address - Country:US
Mailing Address - Phone:713-854-0971
Mailing Address - Fax:
Practice Address - Street 1:2000 CRAWFORD ST STE 105
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-9071
Practice Address - Country:US
Practice Address - Phone:713-854-0971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-23
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX042880183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty