=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912353012
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAUREN YOUNGBERG PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/06/2016
-----------------------------------------------------
Last Update Date | 05/06/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 W EL NORTE PKWY SUITE #11
-----------------------------------------------------
City | ESCONDIDO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92026-2529
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-223-2100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11071 CAMINO PLAYA CARMEL UNIT 1/2
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92124-4141
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-560-8870
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 71640
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------