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NPI Code Detail

MEDICARE: DR. ALISE ELAYNE YOUNG PHARM.D.

MEDICARE: DR. ALISE ELAYNE YOUNG PHARM.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist03-3-20698OH
2183500000XPharmacist11502NV

General Provider Information

NPI Number : 1376544361
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ALISE ELAYNE YOUNG PHARM.D.
Provider Business Mailing Address
First Line : PO BOX 6447
Second Line :
City : CORONA
State : CA
Zip : 92878-6447
Country : US
Telephone Number : 614-325-2861
Fax Number :
Provider Business Practice Location Address
First Line : 800 S MAIN ST
Second Line : PHARMACY
City : CORONA
State : CA
Zip : 92882-3420
Country : US
Telephone Number : 951-736-6305
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/02/2005
Last Update Date : 08/18/2011

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