Provider Demographics
NPI:1669418315
Name:YOUNG'S PHARMACY ,INC.
Entity type:Organization
Organization Name:YOUNG'S PHARMACY ,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:YOUNG
Authorized Official - Middle Name:SOOK
Authorized Official - Last Name:SUNG
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:818-787-9339
Mailing Address - Street 1:7134 VAN NUYS BLVD
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-3005
Mailing Address - Country:US
Mailing Address - Phone:818-787-9339
Mailing Address - Fax:818-787-0189
Practice Address - Street 1:7134 VAN NUYS BLVD
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-3005
Practice Address - Country:US
Practice Address - Phone:818-787-9339
Practice Address - Fax:818-787-0189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY361693336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA361690Medicaid
CA1053630001Medicare ID - Type Unspecified