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General NPI Number Information
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NPI Number | 1407391394
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Entity Type | Individual
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Provider Name | EIA LEE SONG PHARMD
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Gender | Female
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Dates
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Enumeration Date | 12/30/2016
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Last Update Date | 12/30/2016
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Provider Practice Location Address
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Address Line | 2680 REYNOLDS RANCH PKWY
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City | LODI
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State | CA
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Zip | 95240-6848
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Country | US
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Telephone | 209-366-7300
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Fax |
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Provider Business Mailing Address
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Address Line | 4820 WILD GRAPE DR
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City | STOCKTON
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State | CA
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Zip | 95212-2711
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Country | US
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Telephone | 209-518-4975
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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 | 71650
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License Number State | CA
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