Provider Demographics
NPI:1932484193
Name:YOUNG, NICHOLAS EWING (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:EWING
Last Name:YOUNG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3609 CALDERA BLVD APT 217
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-2871
Mailing Address - Country:US
Mailing Address - Phone:405-747-6324
Mailing Address - Fax:
Practice Address - Street 1:215 ANDREWS HWY
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-6331
Practice Address - Country:US
Practice Address - Phone:432-682-8211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist