Active NPI
Elijah Song, PHARMD
- Pharmacist
- Flushing, NY
National Provider Identifier
1447776919
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 063215
- Practice address
- 5810 Myrtle Ave
Flushing, NY 11385-5039 - Phone
- (718) 628-8190
- NPI assigned
- Aug 16, 2017
- Last updated
- Oct 29, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 063215 | NY | Primary |
Addresses
Primary practice location
5810 Myrtle Ave
Flushing, NY 11385-5039
Mailing address
5810 Myrtle Ave
Flushing, NY 11385-5039
Phone (718) 628-8190
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 063215 | Other | NY | LICENSE NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 063215 | NY | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sherman Pharmacy 2 Inc. | Past | Accepting new patients | |
| Myuy Inc | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1502841600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1572307200000",
"number": "1447776919",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5810 MYRTLE AVE",
"city": "FLUSHING",
"state": "NY",
"postal_code": "113855039",
"telephone_number": "718-628-8190"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5810 MYRTLE AVE",
"city": "FLUSHING",
"state": "NY",
"postal_code": "113855039",
"telephone_number": "718-628-8190"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SONG",
"first_name": "ELIJAH",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-08-16",
"last_updated": "2019-10-29",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "063215",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE NUMBER",
"identifier": "063215",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Flushing, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.