1205900693 NPI number — MISS YOUNG R OH PHARM.D.

Table of content: MISS YOUNG R OH PHARM.D. (NPI 1205900693)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205900693 NPI number — MISS YOUNG R OH PHARM.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OH
Provider First Name:
YOUNG
Provider Middle Name:
R
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
PHARM.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OH
Provider Other First Name:
EUNICE
Provider Other Middle Name:
Y
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARM.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1205900693
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/23/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
697 LOUISIANA RD
Provider Second Line Business Mailing Address:
7 MDSS/SGSD DYESS AFB
Provider Business Mailing Address City Name:
ABILENE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79607-1141
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
325-696-4677
Provider Business Mailing Address Fax Number:
325-696-3359

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
697 LOUISIANA RD
Provider Second Line Business Practice Location Address:
7 MDSS/SGSD DYESS AFB
Provider Business Practice Location Address City Name:
ABILENE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79607-1141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
325-696-4677
Provider Business Practice Location Address Fax Number:
325-696-3359
Provider Enumeration Date:
11/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1835P1200X , with the licence number:  50010 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)