Provider Demographics
NPI:1285760447
Name:YOUNG, CHARLOTTE M (RPH)
Entity type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:M
Last Name:YOUNG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 AVENUE C E
Mailing Address - Street 2:PO BOX 192
Mailing Address - City:NAPOLEON
Mailing Address - State:ND
Mailing Address - Zip Code:58561-0192
Mailing Address - Country:US
Mailing Address - Phone:701-754-2563
Mailing Address - Fax:701-754-2203
Practice Address - Street 1:516 AVENUE C EAST
Practice Address - Street 2:
Practice Address - City:NAPOLEON
Practice Address - State:ND
Practice Address - Zip Code:58561-0192
Practice Address - Country:US
Practice Address - Phone:701-754-2563
Practice Address - Fax:701-754-2203
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-24
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4504183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist