Healthcare Provider Details

I. General information

NPI: 1902952864
Provider Name (Legal Business Name): MELISSA DIANE YOUNG PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 03/29/2024
Certification Date: 03/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 S 1300 E
SALT LAKE CITY UT
84105-1927
US

IV. Provider business mailing address

1212 S 1300 E
SALT LAKE CITY UT
84105-1927
US

V. Phone/Fax

Practice location:
  • Phone: 801-557-9904
  • Fax: --
Mailing address:
  • Phone: 801-557-9904
  • Fax: --

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number293562-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: