Provider Demographics
NPI:1508401050
Name:YOUNT, RUSSELL (RPH)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:
Last Name:YOUNT
Suffix:
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 1:1033 LONGFELLOW ST
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-1479
Mailing Address - Country:US
Mailing Address - Phone:816-812-6736
Mailing Address - Fax:
Practice Address - Street 1:1033 LONGFELLOW ST
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-1479
Practice Address - Country:US
Practice Address - Phone:816-812-6736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO042833183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist