Provider Demographics
NPI:1336309764
Name:SONG, JAMIE Y (RPH)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:Y
Last Name:SONG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:HONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:15829 NE 178TH PL
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-9282
Mailing Address - Country:US
Mailing Address - Phone:206-769-5581
Mailing Address - Fax:
Practice Address - Street 1:8629 120TH AVE NE
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-5822
Practice Address - Country:US
Practice Address - Phone:425-822-0414
Practice Address - Fax:425-822-0811
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2024-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00066398183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist