Provider Demographics
NPI:1437287190
Name:YOUNGS PAYLESS PHARMACY
Entity Type:Organization
Organization Name:YOUNGS PAYLESS PHARMACY
Other - Org Name:YOUNGS PAYLESS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACST-IN-CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNNELL
Authorized Official - Suffix:
Authorized Official - Credentials:BS PHARMACY
Authorized Official - Phone:209-727-3762
Mailing Address - Street 1:PO BOX 122
Mailing Address - Street 2:
Mailing Address - City:LOCKEFORD
Mailing Address - State:CA
Mailing Address - Zip Code:95237-0122
Mailing Address - Country:US
Mailing Address - Phone:209-727-3762
Mailing Address - Fax:209-727-3903
Practice Address - Street 1:18980 N HIGHWAY 88
Practice Address - Street 2:
Practice Address - City:LOCKEFORD
Practice Address - State:CA
Practice Address - Zip Code:95237-9787
Practice Address - Country:US
Practice Address - Phone:209-727-3762
Practice Address - Fax:209-727-3903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY419443336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA419440Medicaid
2000134OtherPK