Provider Demographics
NPI:1922407121
Name:YOUNG, MEREDITH LYNN (PHARM D)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:LYNN
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:LYNN
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARM D
Mailing Address - Street 1:1383 HERMANCE RD
Mailing Address - Street 2:
Mailing Address - City:GALWAY
Mailing Address - State:NY
Mailing Address - Zip Code:12074-2801
Mailing Address - Country:US
Mailing Address - Phone:315-771-8810
Mailing Address - Fax:
Practice Address - Street 1:1440 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:COLONIE
Practice Address - State:NY
Practice Address - Zip Code:12205-5118
Practice Address - Country:US
Practice Address - Phone:518-489-0233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY059652183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist