Provider Demographics
NPI:1275837098
Name:YOUNG, SHANNA L (PHARMD)
Entity type:Individual
Prefix:
First Name:SHANNA
Middle Name:L
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 WILLOWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:SALTILLO
Mailing Address - State:MS
Mailing Address - Zip Code:38866-6896
Mailing Address - Country:US
Mailing Address - Phone:662-869-8600
Mailing Address - Fax:662-869-8335
Practice Address - Street 1:111 WILLOWBROOK DR
Practice Address - Street 2:
Practice Address - City:SALTILLO
Practice Address - State:MS
Practice Address - Zip Code:38866-6896
Practice Address - Country:US
Practice Address - Phone:662-869-8600
Practice Address - Fax:662-869-8335
Is Sole Proprietor?:No
Enumeration Date:2011-01-08
Last Update Date:2011-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS09432183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist