Provider Demographics
NPI:1306050653
Name:YOUNG, NELDA YOUNG (PHARMACIST)
Entity type:Individual
Prefix:MRS
First Name:NELDA
Middle Name:YOUNG
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10715
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38308-0111
Mailing Address - Country:US
Mailing Address - Phone:731-668-5011
Mailing Address - Fax:
Practice Address - Street 1:670 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-3934
Practice Address - Country:US
Practice Address - Phone:731-425-6536
Practice Address - Fax:731-425-4931
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN51071835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric