Provider Demographics
NPI:1912523994
Name:YOUNG, BRANT R (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRANT
Middle Name:R
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 1:23 WOODMERE MALL
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-4231
Mailing Address - Country:US
Mailing Address - Phone:931-456-8165
Mailing Address - Fax:931-456-8163
Practice Address - Street 1:23 WOODMERE MALL
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-4231
Practice Address - Country:US
Practice Address - Phone:931-456-8165
Practice Address - Fax:931-456-8163
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37741183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist