Healthcare Provider Details

I. General information

NPI: 1255900114
Provider Name (Legal Business Name): ERIC SONG PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2021
Last Update Date: 06/23/2021
Certification Date: 06/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 W LA VETA AVE
ORANGE CA
92868-4203
US

IV. Provider business mailing address

7615 E KELSEY CT
ANAHEIM CA
92808-1467
US

V. Phone/Fax

Practice location:
  • Phone: 714-509-8856
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH40535
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: