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General NPI Number Information
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NPI Number | 1922524222
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Entity Type | Individual
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Provider Name | JUSTIN SONG PHARMD.
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Gender | Male
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Dates
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Enumeration Date | 08/17/2017
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Last Update Date | 08/17/2017
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Provider Practice Location Address
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Address Line | 3901 W MARKHAM ST
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City | LITTLE ROCK
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State | AR
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Zip | 72205-5527
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Country | US
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Telephone | 501-664-6017
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Fax |
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Provider Business Mailing Address
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Address Line | 3400 S BOWMAN RD APT 1919
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City | LITTLE ROCK
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State | AR
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Zip | 72211-4645
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Country | US
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Telephone | 469-226-9006
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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 | PD14188
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License Number State | AR
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