Provider Demographics
NPI:1952826406
Name:SONG, YONG EUN
Entity Type:Individual
Prefix:DR
First Name:YONG EUN
Middle Name:
Last Name:SONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 JOHN HUNN BROWN RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-4708
Mailing Address - Country:US
Mailing Address - Phone:302-730-9101
Mailing Address - Fax:302-730-3756
Practice Address - Street 1:190 JOHN HUNN BROWN RD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-4708
Practice Address - Country:US
Practice Address - Phone:302-730-9101
Practice Address - Fax:302-730-3756
Is Sole Proprietor?:No
Enumeration Date:2017-08-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24643183500000X
DEA1-0005079183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist