Provider Demographics
NPI:1942588538
Name:YOUNG, TRAVIS M (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:M
Last Name:YOUNG
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:391 E MAKAALA ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-5146
Mailing Address - Country:US
Mailing Address - Phone:808-920-8606
Mailing Address - Fax:808-920-8616
Practice Address - Street 1:391 E MAKAALA ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-5146
Practice Address - Country:US
Practice Address - Phone:808-920-8606
Practice Address - Fax:808-920-8616
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-29
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPH-3211183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist