Provider Demographics
NPI:1013503887
Name:YOUNG, ROBERT JEFFERY (RPH)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JEFFERY
Last Name:YOUNG
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77351-3004
Mailing Address - Country:US
Mailing Address - Phone:936-327-2561
Mailing Address - Fax:936-327-0092
Practice Address - Street 1:1500 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-3004
Practice Address - Country:US
Practice Address - Phone:936-327-2561
Practice Address - Fax:936-327-0092
Is Sole Proprietor?:No
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24288183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist