Provider Demographics
NPI:1073958807
Name:YOUNG, TYLER (PHARMD)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:YOUNG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17617 VASHON HWY SW
Mailing Address - Street 2:
Mailing Address - City:VASHON
Mailing Address - State:WA
Mailing Address - Zip Code:98070-4682
Mailing Address - Country:US
Mailing Address - Phone:206-463-9118
Mailing Address - Fax:206-463-6950
Practice Address - Street 1:17617 VASHON HWY SW
Practice Address - Street 2:
Practice Address - City:VASHON
Practice Address - State:WA
Practice Address - Zip Code:98070-4682
Practice Address - Country:US
Practice Address - Phone:206-463-9118
Practice Address - Fax:206-463-6950
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-07
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIR60099702183500000X
WAPH60369774183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist