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General NPI Number Information
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NPI Number | 1477673325
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Entity Type | Individual
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Provider Name | JASON L YOUNG BS PHARMACY
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Gender | Male
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Dates
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Enumeration Date | 03/31/2007
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Last Update Date | 09/01/2022
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Provider Practice Location Address
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Address Line | 7288 N SHELDON RD STE A
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City | CANTON
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State | MI
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Zip | 48187-2150
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Country | US
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Telephone | 313-831-2008
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Fax | 313-831-2122
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Provider Business Mailing Address
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Address Line | PO BOX 871819
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City | CANTON
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State | MI
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Zip | 48187-7519
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Country | US
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Telephone | 734-812-9129
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Fax | 734-629-1717
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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 | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 5302029980
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License Number State | MI
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