Healthcare Provider Details

I. General information

NPI: 1922537000
Provider Name (Legal Business Name): YOUNG LIFE ENTERPRISE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2017
Last Update Date: 05/04/2025
Certification Date: 05/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1769 CANDLER RD
DECATUR GA
30032-3276
US

IV. Provider business mailing address

1769 CANDLER RD
DECATUR GA
30032-3276
US

V. Phone/Fax

Practice location:
  • Phone: 678-772-8623
  • Fax:
Mailing address:
  • Phone: 404-549-9671
  • Fax: 678-974-5270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. SAMUEL YOUNG II
Title or Position: PHARMACIST
Credential: PHARMD
Phone: 404-549-9671