Provider Demographics
NPI:1659695666
Name:YOUNG, MARJORIE M (RPH)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:M
Last Name:YOUNG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:MARJORIE
Other - Middle Name:J
Other - Last Name:MITTLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:9809 DAUFUSKIE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-9038
Mailing Address - Country:US
Mailing Address - Phone:516-244-4631
Mailing Address - Fax:
Practice Address - Street 1:9809 DAUFUSKIE DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28278-9038
Practice Address - Country:US
Practice Address - Phone:516-244-4631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-19
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042245183500000X
NC27494183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist