Provider Demographics
NPI:1003198748
Name:YOUNG, TONY (RPH)
Entity Type:Individual
Prefix:
First Name:TONY
Middle Name:
Last Name:YOUNG
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 HARDENBURGH AVE
Mailing Address - Street 2:
Mailing Address - City:DEMAREST
Mailing Address - State:NJ
Mailing Address - Zip Code:07627-1306
Mailing Address - Country:US
Mailing Address - Phone:201-750-2550
Mailing Address - Fax:
Practice Address - Street 1:406 E MADISON AVE
Practice Address - Street 2:
Practice Address - City:DUMONT
Practice Address - State:NJ
Practice Address - Zip Code:07628-2629
Practice Address - Country:US
Practice Address - Phone:201-384-8942
Practice Address - Fax:201-501-0296
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02911200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist