Healthcare Provider Details

I. General information

NPI: 1124014626
Provider Name (Legal Business Name): ELIZABETH WOLCOTT YOUNG PHARM.D., BCPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 08/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 S 2000 E RM 201
SALT LAKE CITY UT
84112-5820
US

IV. Provider business mailing address

30 S 2000 E RM 201
SALT LAKE CITY UT
84112-5820
US

V. Phone/Fax

Practice location:
  • Phone: 801-213-3421
  • Fax: 801-585-6599
Mailing address:
  • Phone: 801-213-3421
  • Fax: 801-585-6599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number152383-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: