Provider Demographics
NPI:1073644191
Name:SONG, JUNEYOUNG (RPH)
Entity Type:Individual
Prefix:
First Name:JUNEYOUNG
Middle Name:
Last Name:SONG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1180 MIDLAND AVE APT 4D
Mailing Address - Street 2:
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-6477
Mailing Address - Country:US
Mailing Address - Phone:914-779-2081
Mailing Address - Fax:
Practice Address - Street 1:1180 MIDLAND AVE APT 4D
Practice Address - Street 2:
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-6477
Practice Address - Country:US
Practice Address - Phone:914-779-2081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044027183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist