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General NPI Number Information
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NPI Number | 1437843489
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Entity Type | Individual
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Provider Name | JAEYUL SONG
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Gender | Male
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Dates
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Enumeration Date | 06/05/2023
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Last Update Date | 09/07/2025
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Provider Practice Location Address
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Address Line | 1891 PIONEER PKWY E
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City | SPRINGFIELD
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State | OR
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Zip | 97477-3935
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Country | US
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Telephone | 541-747-6627
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Fax | 541-726-6649
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Provider Business Mailing Address
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Address Line | 2719 31ST ST
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City | SPRINGFIELD
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State | OR
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Zip | 97477-7925
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Country | US
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Telephone |
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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 | 87767
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 0020394
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License Number State | OR
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