Provider Demographics
NPI:1477673325
Name:YOUNG, JASON L (BS PHARMACY)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:L
Last Name:YOUNG
Suffix:
Gender:M
Credentials:BS PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 871819
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-7519
Mailing Address - Country:US
Mailing Address - Phone:734-812-9129
Mailing Address - Fax:734-629-1717
Practice Address - Street 1:7288 N SHELDON RD STE A
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-2150
Practice Address - Country:US
Practice Address - Phone:313-831-2008
Practice Address - Fax:313-831-2122
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-31
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X
MI5302029980183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No174H00000XOther Service ProvidersHealth Educator