Provider Demographics
NPI:1164732178
Name:YOUNG, CLIFFORD A (RPH)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:A
Last Name:YOUNG
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7055 N CHESTNUT AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-0350
Mailing Address - Country:US
Mailing Address - Phone:209-631-3221
Mailing Address - Fax:
Practice Address - Street 1:7055 N CHESTNUT AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-0350
Practice Address - Country:US
Practice Address - Phone:209-631-3221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-12
Last Update Date:2010-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH411071835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric