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NPI Code Detail

MEDICARE: DERICK YOUNG

MEDICARE: DERICK YOUNG
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacistS019606AZ

General Provider Information

NPI Number : 1164844601
Entity Type Code : Individual
Provider Name (Legal Business Name) : DERICK YOUNG
Provider Business Mailing Address
First Line : 18330 N 79TH AVE APT 2066
Second Line :
City : GLENDALE
State : AZ
Zip : 85308-8351
Country : US
Telephone Number : 630-205-4840
Fax Number :
Provider Business Practice Location Address
First Line : 6145 N 35TH AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85017-1940
Country : US
Telephone Number : 602-973-6561
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/17/2014
Last Update Date : 01/17/2014

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Directions to “ DERICK YOUNG ” Practice Location

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