Provider Demographics
NPI:1932741766
Name:YOUNG, WARREN (RPH)
Entity Type:Individual
Prefix:
First Name:WARREN
Middle Name:
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 1:1550 S REDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84104-5105
Mailing Address - Country:US
Mailing Address - Phone:801-974-1440
Mailing Address - Fax:801-973-1704
Practice Address - Street 1:1550 S REDWOOD RD
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84104-5105
Practice Address - Country:US
Practice Address - Phone:801-974-1440
Practice Address - Fax:801-973-1704
Is Sole Proprietor?:No
Enumeration Date:2019-10-14
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT146561-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist