Provider Demographics
NPI:1306053202
Name:YOUNG HARRIS PHARMACY, INC
Entity type:Organization
Organization Name:YOUNG HARRIS PHARMACY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST PRES.
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:COCHRAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:706-379-3700
Mailing Address - Street 1:PO BOX 25
Mailing Address - Street 2:
Mailing Address - City:YOUNG HARRIS
Mailing Address - State:GA
Mailing Address - Zip Code:30582-0025
Mailing Address - Country:US
Mailing Address - Phone:706-379-3700
Mailing Address - Fax:706-379-1040
Practice Address - Street 1:HWY 66 & US 76
Practice Address - Street 2:
Practice Address - City:YOUNG HARRIS
Practice Address - State:GA
Practice Address - Zip Code:30582-0025
Practice Address - Country:US
Practice Address - Phone:706-379-3700
Practice Address - Fax:706-379-1040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0058633336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy