Provider Demographics
NPI:1134205503
Name:YOUNG, MARY MARGARET (RPH)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:MARGARET
Last Name:YOUNG
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 1:6412 AUTUMN RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695-3208
Mailing Address - Country:US
Mailing Address - Phone:251-661-6543
Mailing Address - Fax:
Practice Address - Street 1:5600 GIRBY RD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36693-3320
Practice Address - Country:US
Practice Address - Phone:251-660-5925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7325183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist