MEDICARE: DR. MELISSA DIANE YOUNG PHARMD

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	133NN1002X	Nutrition Education Nutritionist
2	1835P1200X	Pharmacotherapy Pharmacist	293562-1701	UT

General Provider Information

NPI Number	:	1902952864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELISSA DIANE YOUNG PHARMD

Provider Business Mailing Address
First Line	:	1212 S 1300 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-1927
Country	:	US
Telephone Number	:	801-557-9904
Fax Number	:	--

Provider Business Practice Location Address
First Line	:	1212 S 1300 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-1927
Country	:	US
Telephone Number	:	801-557-9904
Fax Number	:	--

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

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	03/29/2024

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