Provider Demographics
NPI:1174854178
Name:SONG, JOEY (RPH)
Entity type:Individual
Prefix:
First Name:JOEY
Middle Name:
Last Name:SONG
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 1:859 NE NORTHGATE WAY
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-7311
Mailing Address - Country:US
Mailing Address - Phone:206-417-0520
Mailing Address - Fax:206-417-0559
Practice Address - Street 1:859 NE NORTHGATE WAY
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-7311
Practice Address - Country:US
Practice Address - Phone:206-417-0520
Practice Address - Fax:206-417-0559
Is Sole Proprietor?:No
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00042876183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist