Provider Demographics
NPI:1659823607
Name:YOUNG, LANDIS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LANDIS
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 1:1203 BLUE STEM CIR
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-0814
Mailing Address - Country:US
Mailing Address - Phone:402-640-5135
Mailing Address - Fax:
Practice Address - Street 1:1300 W NORFOLK AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-4834
Practice Address - Country:US
Practice Address - Phone:402-371-2340
Practice Address - Fax:402-371-9199
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE14865183500000X
MO2013028398183500000X
IA22449183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist