Provider Demographics
NPI:1679972186
Name:YOUNG-SMITH, BEA (RPH)
Entity Type:Individual
Prefix:
First Name:BEA
Middle Name:
Last Name:YOUNG-SMITH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3063 PHOEBE LANE
Mailing Address - Street 2:
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645
Mailing Address - Country:US
Mailing Address - Phone:828-754-2184
Mailing Address - Fax:828-754-2462
Practice Address - Street 1:3063 PHOEBE LN
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-8878
Practice Address - Country:US
Practice Address - Phone:828-754-2184
Practice Address - Fax:828-754-2462
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC006721183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist