Provider Demographics
NPI:1003047101
Name:YOUNG, JULIE LYNN (PHARMD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:LYNN
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:BLACK RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:13612-3159
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1655 STATE STREET
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601
Practice Address - Country:US
Practice Address - Phone:315-785-1088
Practice Address - Fax:315-785-1991
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052202183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist