Healthcare Provider Details

I. General information

NPI: 1629985205
Provider Name (Legal Business Name): FORREST JOHN YOUNG RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E 2ND ST
MERRILL WI
54452-2317
US

IV. Provider business mailing address

N3003 MAPLEWOOD RD
MERRILL WI
54452-9412
US

V. Phone/Fax

Practice location:
  • Phone: 715-536-2909
  • Fax: 715-536-5094
Mailing address:
  • Phone: 715-842-0370
  • Fax: 715-842-0366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12624-040
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: