Provider Demographics
NPI:1821401365
Name:SONG, ANDREW (PHARMD)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:
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 1:24975 PICO CANYON RD
Mailing Address - Street 2:
Mailing Address - City:STEVENSON RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91381-1708
Mailing Address - Country:US
Mailing Address - Phone:661-253-0320
Mailing Address - Fax:661-253-3083
Practice Address - Street 1:24975 PICO CANYON RD
Practice Address - Street 2:
Practice Address - City:STEVENSON RANCH
Practice Address - State:CA
Practice Address - Zip Code:91381-1708
Practice Address - Country:US
Practice Address - Phone:661-253-0320
Practice Address - Fax:661-253-3083
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50409183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist