Provider Demographics
NPI:1457957565
Name:SON, JI YEONG (PHARMD)
Entity Type:Individual
Prefix:
First Name:JI YEONG
Middle Name:
Last Name:SON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4315 MARLTON PIKE
Mailing Address - Street 2:
Mailing Address - City:PENNSAUKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08109-4400
Mailing Address - Country:US
Mailing Address - Phone:856-910-8040
Mailing Address - Fax:
Practice Address - Street 1:4315 MARLTON PIKE
Practice Address - Street 2:
Practice Address - City:PENNSAUKEN
Practice Address - State:NJ
Practice Address - Zip Code:08109-4400
Practice Address - Country:US
Practice Address - Phone:856-910-8040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-05
Last Update Date:2020-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04066000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI04066000OtherN/A