Healthcare Provider Details

I. General information

NPI: 1417252305
Provider Name (Legal Business Name): LISA A YOUNG PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2011
Last Update Date: 01/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 E COY SMITH HWY
MOUNT VERNON AL
36560-3322
US

IV. Provider business mailing address

725 E COY SMITH HWY
MOUNT VERNON AL
36560-3322
US

V. Phone/Fax

Practice location:
  • Phone: 251-662-6837
  • Fax: 251-829-5636
Mailing address:
  • Phone: 251-662-6837
  • Fax: 251-829-5636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13895
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: