Provider Demographics
NPI:1811010648
Name:YOUNG, MARILYN ANN (RPH)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:ANN
Last Name:YOUNG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:MARILYN
Other - Middle Name:ANN
Other - Last Name:RUSSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7537 HOLLIDAY DR W
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-3642
Mailing Address - Country:US
Mailing Address - Phone:317-253-1153
Mailing Address - Fax:
Practice Address - Street 1:3850 SHORE DR
Practice Address - Street 2:SUITE 111
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-5621
Practice Address - Country:US
Practice Address - Phone:317-299-3771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26015234A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist