Provider Demographics
NPI:1376544361
Name:YOUNG, ALISE ELAYNE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ALISE
Middle Name:ELAYNE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:ALISE
Other - Middle Name:ELAYNE
Other - Last Name:HADLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:PO BOX 6447
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92878-6447
Mailing Address - Country:US
Mailing Address - Phone:614-325-2861
Mailing Address - Fax:
Practice Address - Street 1:800 S MAIN ST
Practice Address - Street 2:PHARMACY
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-3420
Practice Address - Country:US
Practice Address - Phone:951-736-6305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-20698183500000X
NV11502183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist