Provider Demographics
NPI:1710092879
Name:STILES-YOUNT, DENISE ANN (RPH)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:ANN
Last Name:STILES-YOUNT
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 1:12875 RABBIT RUN LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-1077
Mailing Address - Country:US
Mailing Address - Phone:904-221-3147
Mailing Address - Fax:904-723-2671
Practice Address - Street 1:6022 ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-7503
Practice Address - Country:US
Practice Address - Phone:904-725-1616
Practice Address - Fax:904-723-2671
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19852183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFL19852OtherSTATE LICENSE NUMBER