Provider Demographics
NPI:1912131210
Name:SONG, DWIGHT J (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DWIGHT
Middle Name:J
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 1:2018 GRIFFITH PARK BLVD
Mailing Address - Street 2:APT #124
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039-3563
Mailing Address - Country:US
Mailing Address - Phone:213-718-0381
Mailing Address - Fax:
Practice Address - Street 1:2018 GRIFFITH PARK BLVD
Practice Address - Street 2:APT #. 124
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90039-3563
Practice Address - Country:US
Practice Address - Phone:213-718-0381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-14
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA621651835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist