MEDICARE: KIMBERLY MICHELLE 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	183500000X	Pharmacist	03439836	OH

General Provider Information

NPI Number	:	1952906364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY MICHELLE YOUNG PHARMD

Provider Business Mailing Address
First Line	:	1936 EDGEWOOD DR
Second Line	:
City	:	TWINSBURG
State	:	OH
Zip	:	44087-1621
Country	:	US
Telephone Number	:	567-208-1251
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 N CLEVELAND AVE
Second Line	:
City	:	MOGADORE
State	:	OH
Zip	:	44260-1365
Country	:	US
Telephone Number	:	330-628-1717
Fax Number	:

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

Provider Enumeration Date	:	12/02/2020
Last Update Date	:	12/02/2020

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