Provider Demographics
NPI:1700171840
Name:YOUNG, MATTHEW C (RPH)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:C
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 1:120 W GRANT ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-3932
Mailing Address - Country:US
Mailing Address - Phone:407-608-1581
Mailing Address - Fax:407-608-1591
Practice Address - Street 1:120 W GRANT ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-3932
Practice Address - Country:US
Practice Address - Phone:407-608-1581
Practice Address - Fax:407-608-1591
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS35424183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist