Provider Demographics
NPI:1063027530
Name:YOUNG, MATTHEW GLENN (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:GLENN
Last Name:YOUNG
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2755 N RAMADA CIR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85215-1624
Mailing Address - Country:US
Mailing Address - Phone:813-334-7686
Mailing Address - Fax:
Practice Address - Street 1:4631 S POWER RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-4223
Practice Address - Country:US
Practice Address - Phone:480-750-1635
Practice Address - Fax:623-444-3198
Is Sole Proprietor?:No
Enumeration Date:2020-09-11
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS012109183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist