Healthcare Provider Details

I. General information

NPI: 1255941282
Provider Name (Legal Business Name): SONG YI HAN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2020
Last Update Date: 08/04/2020
Certification Date: 08/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4224 E SHIELDS AVE
FRESNO CA
93726-7120
US

IV. Provider business mailing address

8680 N GLENN AVE APT 167
FRESNO CA
93711-6941
US

V. Phone/Fax

Practice location:
  • Phone: 559-271-5030
  • Fax:
Mailing address:
  • Phone: 408-890-0388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number81362
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: