Basic Information
| Provider Information | |||||||||
| NPI: | 1477673325 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YOUNG | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | BS PHARMACY | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 871819 | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481877519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7348129129 | ||||||||
| FaxNumber: | 7346291717 | ||||||||
| Practice Location | |||||||||
| Address1: | 7288 N SHELDON RD STE A | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481872150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3138312008 | ||||||||
| FaxNumber: | 3138312122 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2007 | ||||||||
| LastUpdateDate: | 09/01/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174H00000X | N | Other Service Providers | Health Educator | 183500000X | 5302029980 | MI | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.