Provider Demographics
NPI:1699032102
Name:SONG, CASSANDRA MOON (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:MOON
Last Name:SONG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24212 63RD WAY S
Mailing Address - Street 2:APT 4-302
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-4651
Mailing Address - Country:US
Mailing Address - Phone:818-825-1416
Mailing Address - Fax:
Practice Address - Street 1:1660 S COLUMBIAN WAY
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-1532
Practice Address - Country:US
Practice Address - Phone:206-277-4573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-20
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60554320183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist