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General NPI Number Information
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NPI Number | 1265029292
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Entity Type | Individual
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Provider Name | ALEXANDER RANDALL YOUNG
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Gender | Male
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Dates
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Enumeration Date | 12/23/2020
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Last Update Date | 12/23/2020
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Provider Practice Location Address
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Address Line | 2215 N STATE ROAD 3 BYP
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City | GREENSBURG
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State | IN
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Zip | 47240
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Country | US
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Telephone | 812-662-0936
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Fax |
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Provider Business Mailing Address
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Address Line | 1510 N HASMER HILL RD
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City | OSGOOD
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State | IN
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Zip | 47037
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Country | US
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Telephone | 812-560-8652
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 26029042A
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License Number State | IN
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