Healthcare Provider Details

I. General information

NPI: 1306954706
Provider Name (Legal Business Name): RANDALL THEODORE YOUNG RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2006
Last Update Date: 01/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1571 KY HIGHWAY 259 N
BROWNSVILLE KY
42210-9206
US

IV. Provider business mailing address

1571 KY HIGHWAY 259 N PO BOX 540
BROWNSVILLE KY
42210-9206
US

V. Phone/Fax

Practice location:
  • Phone: 270-597-9514
  • Fax: 270-597-3232
Mailing address:
  • Phone: 270-597-9514
  • Fax: 270-597-3232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number011609
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: