Provider Demographics
NPI:1851562920
Name:NA, MI YOUNG (RPH)
Entity Type:Individual
Prefix:
First Name:MI YOUNG
Middle Name:
Last Name:NA
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 1:460 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:11010-1260
Mailing Address - Country:US
Mailing Address - Phone:516-352-4667
Mailing Address - Fax:516-358-1974
Practice Address - Street 1:460 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN SQUARE
Practice Address - State:NY
Practice Address - Zip Code:11010-1260
Practice Address - Country:US
Practice Address - Phone:516-352-4667
Practice Address - Fax:516-358-1947
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-17
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046965183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist