MEDICARE: MR. ANDREW SONG PHARMD

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	50409	CA

General Provider Information

NPI Number	:	1821401365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANDREW SONG PHARMD

Provider Business Mailing Address
First Line	:	24975 PICO CANYON RD
Second Line	:
City	:	STEVENSON RANCH
State	:	CA
Zip	:	91381-1708
Country	:	US
Telephone Number	:	661-253-0320
Fax Number	:	661-253-3083

Provider Business Practice Location Address
First Line	:	24975 PICO CANYON RD
Second Line	:
City	:	STEVENSON RANCH
State	:	CA
Zip	:	91381-1708
Country	:	US
Telephone Number	:	661-253-0320
Fax Number	:	661-253-3083

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

Provider Enumeration Date	:	06/03/2014
Last Update Date	:	06/03/2014

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