Provider Demographics
NPI:1215037783
Name:YOUNG, JOSEPH LEE (RPH)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:LEE
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 1:101 GLENVIEW CT
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49014
Mailing Address - Country:US
Mailing Address - Phone:269-969-9003
Mailing Address - Fax:269-789-3975
Practice Address - Street 1:200 N MADISON ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MI
Practice Address - Zip Code:49068-1143
Practice Address - Country:US
Practice Address - Phone:269-789-8999
Practice Address - Fax:269-789-3975
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302021789183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist