Provider Demographics
NPI:1710269956
Name:YOUNT, RANDY (RPH)
Entity Type:Individual
Prefix:
First Name:RANDY
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 1:9933 STATE ROUTE 700
Mailing Address - Street 2:
Mailing Address - City:MANTUA
Mailing Address - State:OH
Mailing Address - Zip Code:44255-9730
Mailing Address - Country:US
Mailing Address - Phone:216-246-1318
Mailing Address - Fax:
Practice Address - Street 1:144 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-3130
Practice Address - Country:US
Practice Address - Phone:330-298-4297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03323924183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist