Provider Demographics
NPI:1164696621
Name:YOUNG, CHARLES R (RPH, CFE)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:R
Last Name:YOUNG
Suffix:
Gender:M
Credentials:RPH, CFE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 EASTLEIGH LN
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-4275
Mailing Address - Country:US
Mailing Address - Phone:508-655-2010
Mailing Address - Fax:
Practice Address - Street 1:12 EASTLEIGH LN
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-4275
Practice Address - Country:US
Practice Address - Phone:508-655-2010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15231183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist