Healthcare Provider Details

I. General information

NPI: 1477673325
Provider Name (Legal Business Name): JASON L YOUNG BS PHARMACY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2007
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7288 N SHELDON RD STE A
CANTON MI
48187-2150
US

IV. Provider business mailing address

PO BOX 871819
CANTON MI
48187-7519
US

V. Phone/Fax

Practice location:
  • Phone: 313-831-2008
  • Fax: 313-831-2122
Mailing address:
  • Phone: 734-812-9129
  • Fax: 734-629-1717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302029980
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: