Provider Demographics
NPI:1104118793
Name:YOUNGER, STEPHANIE BELTON
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:BELTON
Last Name:YOUNGER
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:STEPHANIE
Other - Middle Name:DENISE
Other - Last Name:BELTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3540 MOUNT HOLLY HUNTERSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-8644
Mailing Address - Country:US
Mailing Address - Phone:704-395-0572
Mailing Address - Fax:704-395-0623
Practice Address - Street 1:3540 MOUNT HOLLY HUNTERSVILLE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-8644
Practice Address - Country:US
Practice Address - Phone:704-395-0572
Practice Address - Fax:704-395-0623
Is Sole Proprietor?:No
Enumeration Date:2011-05-14
Last Update Date:2011-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15203183500000X
VA0202012595183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist