MEDICARE: MR. RANDALL THEODORE YOUNG RPH

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
1	183500000X	Pharmacist	011609	KY

General Provider Information

NPI Number	:	1306954706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RANDALL THEODORE YOUNG RPH

Provider Business Mailing Address
First Line	:	1571 KY HIGHWAY 259 N
Second Line	:	PO BOX 540
City	:	BROWNSVILLE
State	:	KY
Zip	:	42210-9206
Country	:	US
Telephone Number	:	270-597-9514
Fax Number	:	270-597-3232

Provider Business Practice Location Address
First Line	:	1571 KY HIGHWAY 259 N
Second Line	:
City	:	BROWNSVILLE
State	:	KY
Zip	:	42210-9206
Country	:	US
Telephone Number	:	270-597-9514
Fax Number	:	270-597-3232

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2006
Last Update Date	:	01/14/2013

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