Provider Demographics
NPI:1457337339
Name:YOUNG, SHELBY GLEN (R PH)
Entity Type:Individual
Prefix:MR
First Name:SHELBY
Middle Name:GLEN
Last Name:YOUNG
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1391 HICKORYVIEW CT
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45458-9681
Mailing Address - Country:US
Mailing Address - Phone:937-885-4499
Mailing Address - Fax:
Practice Address - Street 1:605 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45345-9173
Practice Address - Country:US
Practice Address - Phone:937-687-9711
Practice Address - Fax:937-687-7052
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-12661183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist