Provider Demographics
NPI:1811265374
Name:YOUNG, MICHAEL R (RPH)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
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 1:4707 SAINT ANTOINE ST
Mailing Address - Street 2:SUITE M230
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-1427
Mailing Address - Country:US
Mailing Address - Phone:313-966-0392
Mailing Address - Fax:
Practice Address - Street 1:3922 BRIARBROOKE LN
Practice Address - Street 2:
Practice Address - City:OAKLAND TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48306-4749
Practice Address - Country:US
Practice Address - Phone:248-804-4139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-12
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202007562183500000X
PARP038059R183500000X
MI5302035592183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist