=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629985205
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FORREST JOHN YOUNG RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/27/2026
-----------------------------------------------------
Last Update Date | 08/27/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 301 E 2ND ST
-----------------------------------------------------
City | MERRILL
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54452-2317
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-536-2909
-----------------------------------------------------
Fax | 715-536-5094
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | N3003 MAPLEWOOD RD
-----------------------------------------------------
City | MERRILL
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54452-9412
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-842-0370
-----------------------------------------------------
Fax | 715-842-0366
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 12624-040
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------