MEDICARE: JUSTIN 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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	24972	NV
2	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	PD14188	AR

General Provider Information

NPI Number	:	1922524222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN SONG PHARMD.

Provider Business Mailing Address
First Line	:	11611 LAS VEGAS BLVD S UNIT 2027
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89183-5074
Country	:	US
Telephone Number	:	469-226-9006
Fax Number	:

Provider Business Practice Location Address
First Line	:	2211 N RAMPART BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-7640
Country	:	US
Telephone Number	:	702-256-1984
Fax Number	:

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

Provider Enumeration Date	:	08/17/2017
Last Update Date	:	05/30/2026

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Directions to “ JUSTIN SONG PHARMD.” Practice Location

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