Healthcare Provider Details

I. General information

NPI: 1699876805
Provider Name (Legal Business Name): JAMES NICHOLAS YOUNG III RPH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 S CLARK ST
ALBION MI
49224-1915
US

IV. Provider business mailing address

310 SHERMAN DR
MARSHALL MI
49068-9616
US

V. Phone/Fax

Practice location:
  • Phone: 517-629-2900
  • Fax: 517-629-7820
Mailing address:
  • Phone: 269-781-5203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302020385
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: