=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972099448
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOANNA YOUNG PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2018
-----------------------------------------------------
Last Update Date | 07/07/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 414 NAVARRO ST STE 1702
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78205-2507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-271-1990
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5303 HAMILTON WOLFE RD APT 502
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78229-4362
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-403-8032
-----------------------------------------------------
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 | 62207
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------