Provider Demographics
NPI:1154318442
Name:YOUNG BROTHERS PHARMACY, INC.
Entity Type:Organization
Organization Name:YOUNG BROTHERS PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:D
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:770-382-4010
Mailing Address - Street 1:2 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-3506
Mailing Address - Country:US
Mailing Address - Phone:770-382-4010
Mailing Address - Fax:770-386-0384
Practice Address - Street 1:2 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-3506
Practice Address - Country:US
Practice Address - Phone:770-382-4010
Practice Address - Fax:770-386-0384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3256183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0234670001Medicare ID - Type Unspecified