Healthcare Provider Details

I. General information

NPI: 1407164163
Provider Name (Legal Business Name): AMY YOUNG CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2010
Last Update Date: 09/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10375 RICHMOND AVE SUITE 1575
HOUSTON TX
77042-4143
US

IV. Provider business mailing address

10375 RICHMOND AVE SUITE 1575
HOUSTON TX
77042-4143
US

V. Phone/Fax

Practice location:
  • Phone: 713-541-1177
  • Fax: 713-513-5924
Mailing address:
  • Phone: 713-541-1177
  • Fax: 713-513-5924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number07313351
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: