Healthcare Provider Details

I. General information

NPI: 1932558855
Provider Name (Legal Business Name): KAYLA YOUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2016
Last Update Date: 06/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 ROOSEVELT BLVD
ELEANOR WV
25070
US

IV. Provider business mailing address

501 ROOSEVELT BLVD
ELEANOR WV
25070
US

V. Phone/Fax

Practice location:
  • Phone: 304-586-0886
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number0008398
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: