Healthcare Provider Details

I. General information

NPI: 1982984803
Provider Name (Legal Business Name): BRENDA YOUNG PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2011
Last Update Date: 08/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2951 COTTINGHAM EXPY
PINEVILLE LA
71360-4389
US

IV. Provider business mailing address

2951 COTTINGHAM EXPY
PINEVILLE LA
71360-4389
US

V. Phone/Fax

Practice location:
  • Phone: 318-640-0145
  • Fax: 866-557-3455
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number017493
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: