Provider Demographics
NPI:1265031256
Name:SONG, JAMES JIWON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:JIWON
Last Name:SONG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5624 220TH ST
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-1934
Mailing Address - Country:US
Mailing Address - Phone:917-886-5416
Mailing Address - Fax:
Practice Address - Street 1:421 GLEN COVE RD
Practice Address - Street 2:
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577-1811
Practice Address - Country:US
Practice Address - Phone:516-621-5959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-20
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY068797183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist