MEDICARE: KELLEY SONG PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	46604	CA

General Provider Information

NPI Number	:	1649385022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLEY SONG PHARM.D.

Provider Business Mailing Address
First Line	:	1339 W GARVEY AVE N
Second Line	:
City	:	WEST COVINA
State	:	CA
Zip	:	91790-2242
Country	:	US
Telephone Number	:	626-814-0111
Fax Number	:	888-216-2114

Provider Business Practice Location Address
First Line	:	1339 W GARVEY AVE N
Second Line	:
City	:	WEST COVINA
State	:	CA
Zip	:	91790-2242
Country	:	US
Telephone Number	:	626-814-0111
Fax Number	:	888-216-2114

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	07/08/2007

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Directions to “ KELLEY SONG PHARM.D.” Practice Location

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