Healthcare Provider Details

I. General information

NPI: 1538498548
Provider Name (Legal Business Name): YU SONG PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAURA SONG PHARM D

II. Dates (important events)

Enumeration Date: 12/22/2009
Last Update Date: 04/15/2020
Certification Date: 04/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WORLD TRADE CTR FL 8
LONG BEACH CA
90831-0002
US

IV. Provider business mailing address

1835 CHESTNUT ST APT 3R
PHILADELPHIA PA
19103-3702
US

V. Phone/Fax

Practice location:
  • Phone:
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License NumberRP442562
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code1835N1003X
TaxonomyNutrition Support Pharmacist
License NumberRP442562
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRP442562
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberRP442562
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License NumberRP442562
License Number StatePA
# 6
Primary TaxonomyN
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License NumberRP442562
License Number StatePA
# 7
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP442562
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: