Provider Demographics
NPI:1477881555
Name:YOUNG, VIRGIL EVERETT JR (RPH)
Entity Type:Individual
Prefix:
First Name:VIRGIL
Middle Name:EVERETT
Last Name:YOUNG
Suffix:JR
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 1:131 OYSTER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-4157
Mailing Address - Country:US
Mailing Address - Phone:979-292-0328
Mailing Address - Fax:
Practice Address - Street 1:131 OYSTER CREEK DR
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-4157
Practice Address - Country:US
Practice Address - Phone:979-292-0328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-30
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20537183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist