Provider Demographics
NPI:1538436506
Name:SONG, JINA J (PHARM D)
Entity type:Individual
Prefix:DR
First Name:JINA
Middle Name:J
Last Name:SONG
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WINSTON DR APT 16BS
Mailing Address - Street 2:
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-3375
Mailing Address - Country:US
Mailing Address - Phone:201-317-5225
Mailing Address - Fax:
Practice Address - Street 1:100 WINSTON DR APT 16BS
Practice Address - Street 2:
Practice Address - City:CLIFFSIDE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07010-3375
Practice Address - Country:US
Practice Address - Phone:201-317-5225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-18
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03017500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist