Healthcare Provider Details

I. General information

NPI: 1306821574
Provider Name (Legal Business Name): GERALD JAMES YOUNG JR. RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/10/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

579 SPRUCE ST
MONTE VISTA CO
81144-9431
US

IV. Provider business mailing address

579 SPRUCE ST
MONTE VISTA CO
81144-9431
US

V. Phone/Fax

Practice location:
  • Phone: 719-852-5063
  • Fax: 719-852-3566
Mailing address:
  • Phone: 719-852-5063
  • Fax: 719-852-3566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10330
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: