Provider Demographics
NPI:1255941282
Name:HAN, SONG YI (RPH)
Entity type:Individual
Prefix:
First Name:SONG
Middle Name:YI
Last Name:HAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8680 N GLENN AVE APT 167
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-6941
Mailing Address - Country:US
Mailing Address - Phone:408-890-0388
Mailing Address - Fax:
Practice Address - Street 1:4224 E SHIELDS AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-7120
Practice Address - Country:US
Practice Address - Phone:559-271-5030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81362183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist