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General NPI Number Information
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NPI Number | 1104074509
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Entity Type | Individual
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Provider Name | LISA RENE YOUNG PHARM.D.
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Gender | Female
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Dates
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Enumeration Date | 08/28/2008
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Last Update Date | 07/15/2025
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Provider Practice Location Address
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Address Line | 820 S DAMEN AVE DEPARTMENT OF PHARMACY (119)
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City | CHICAGO
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State | IL
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Zip | 60612-3728
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Country | US
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Telephone | 312-569-7949
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Fax | 312-569-6185
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Provider Business Mailing Address
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Address Line | 420 N JAMES RD DEPT OF
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City | COLUMBUS
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State | OH
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Zip | 43219-1834
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Country | US
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Telephone | 614-257-5552
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 051.293032
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License Number State | IL
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