Healthcare Provider Details

I. General information

NPI: 1548506314
Provider Name (Legal Business Name): YU LEE SONG PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2012
Last Update Date: 12/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1528 E AMAR RD
WEST COVINA CA
91792-1618
US

IV. Provider business mailing address

4328 SAWGRASS CT
CHINO HILLS CA
91709-3399
US

V. Phone/Fax

Practice location:
  • Phone: 626-965-2016
  • Fax: 626-965-5386
Mailing address:
  • Phone: 909-342-3688
  • Fax: 909-393-0363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number67700
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: