Provider Demographics
NPI:1114201720
Name:YOUNG, JASSONI SHAE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:JASSONI
Middle Name:SHAE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7110 YOUREE DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5107
Mailing Address - Country:US
Mailing Address - Phone:318-798-7860
Mailing Address - Fax:318-798-7860
Practice Address - Street 1:7110 YOUREE DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5107
Practice Address - Country:US
Practice Address - Phone:318-798-7860
Practice Address - Fax:318-798-7860
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA019494183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist