MEDICARE: AMY K YOUNGMAN RPH

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
1	183500000X	Pharmacist	RPH020775	GA

General Provider Information

NPI Number	:	1386769974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY K YOUNGMAN RPH

Provider Business Mailing Address
First Line	:	951 GLENWOOD AVE SE
Second Line	:	#1801
City	:	ATLANTA
State	:	GA
Zip	:	30316-1886
Country	:	US
Telephone Number	:	404-873-1417
Fax Number	:

Provider Business Practice Location Address
First Line	:	1874 PIEDMONT AVE NE
Second Line	:	BLDG A,SUITE A
City	:	ATLANTA
State	:	GA
Zip	:	30324-4869
Country	:	US
Telephone Number	:	404-733-6800
Fax Number	:	404-733-6880

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	07/08/2007

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