Provider Demographics
NPI:1124447537
Name:SULLIVAN, SONG HYE (DOCTOR OF PHARMACY)
Entity type:Individual
Prefix:
First Name:SONG
Middle Name:HYE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:DOCTOR OF PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9880 DORCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-8545
Mailing Address - Country:US
Mailing Address - Phone:843-871-2550
Mailing Address - Fax:843-871-3310
Practice Address - Street 1:9880 DORCHESTER RD
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-8545
Practice Address - Country:US
Practice Address - Phone:843-871-2550
Practice Address - Fax:843-871-3310
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-14
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11434183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist