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General NPI Number Information
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NPI Number | 1043852114
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Entity Type | Individual
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Provider Name | CICILY YOUNG SONG PHARM.D
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Gender | Female
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Dates
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Enumeration Date | 10/10/2019
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Last Update Date | 10/10/2019
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Provider Practice Location Address
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Address Line | 417 W ROCK ISLAND AVE
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City | BOYD
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State | TX
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Zip | 76023-3103
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Country | US
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Telephone | 940-433-8056
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Fax |
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Provider Business Mailing Address
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Address Line | 3535 BLUFFS LN APT 14301
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City | GRAPEVINE
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State | TX
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Zip | 76051-1252
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Country | US
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Telephone | 940-594-5091
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 61151
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License Number State | TX
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