Individual
YESUL SONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1301 15TH AVE W, WILLISTON, ND 58801-3821
(701) 774-7400
Mailing address
3103 3RD AVE E, #208, WILLISTON, ND 58801
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH6090
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SON-93-4616
DRIVER'S LICENSE
—
Enumeration date
12/05/2018
Last updated
12/05/2018
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