Provider Demographics
NPI:1417641598
Name:YOUNG, BRONSON (PHARM D)
Entity Type:Individual
Prefix:
First Name:BRONSON
Middle Name:
Last Name:YOUNG
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2380 N 400 E STE E
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-1767
Mailing Address - Country:US
Mailing Address - Phone:435-787-1212
Mailing Address - Fax:
Practice Address - Street 1:2380 N 400 E STE E
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-1767
Practice Address - Country:US
Practice Address - Phone:435-787-1212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11784337-1721183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist