Provider Demographics
NPI:1497949085
Name:YOUNG, MILLER (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MILLER
Middle Name:
Last Name:YOUNG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 DOVER DR
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054-9724
Mailing Address - Country:US
Mailing Address - Phone:518-674-3663
Mailing Address - Fax:518-674-1400
Practice Address - Street 1:1636 BURDEN LAKE ROAD
Practice Address - Street 2:
Practice Address - City:AVERILL PARK
Practice Address - State:NY
Practice Address - Zip Code:12018-2808
Practice Address - Country:US
Practice Address - Phone:518-674-3663
Practice Address - Fax:518-674-1400
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048744183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist