Provider Demographics
NPI:1750007373
Name:YOUNG, JOHN TYLER (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:TYLER
Last Name:YOUNG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:BARNESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30204-1602
Mailing Address - Country:US
Mailing Address - Phone:770-358-2266
Mailing Address - Fax:770-358-4497
Practice Address - Street 1:302 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:BARNESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30204-1602
Practice Address - Country:US
Practice Address - Phone:770-358-2266
Practice Address - Fax:770-358-4497
Is Sole Proprietor?:No
Enumeration Date:2022-10-14
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH030633183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1OtherNOT APPLICABLE