Healthcare Provider Details

I. General information

NPI: 1265145916
Provider Name (Legal Business Name): JACOB YOUNG PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2022
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 W MARION RD
MOUNT GILEAD OH
43338-1025
US

IV. Provider business mailing address

432 WALNUTVIEW DR
SUNBURY OH
43074-9459
US

V. Phone/Fax

Practice location:
  • Phone: 419-947-9134
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03442715
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: