Provider Demographics
NPI:1689274300
Name:YOON, SONG (RPH)
Entity Type:Individual
Prefix:MR
First Name:SONG
Middle Name:
Last Name:YOON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8555 PRESTON RD
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-5606
Mailing Address - Country:US
Mailing Address - Phone:469-237-3785
Mailing Address - Fax:469-237-3771
Practice Address - Street 1:8555 PRESTON RD
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-5606
Practice Address - Country:US
Practice Address - Phone:469-237-3785
Practice Address - Fax:469-237-3771
Is Sole Proprietor?:No
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31677183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist