Healthcare Provider Details

I. General information

NPI: 1154209088
Provider Name (Legal Business Name): YOUNGJOO SONG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 CHIEF JUSTICE CUSHING HWY
COHASSET MA
02025-2140
US

IV. Provider business mailing address

790 CHIEF JUSTICE CUSHING HWY
COHASSET MA
02025-2140
US

V. Phone/Fax

Practice location:
  • Phone: 781-383-1525
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH1000774
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: