Provider Demographics
NPI:1306121868
Name:YOUNG, MARTINA TERESA (BS)
Entity type:Individual
Prefix:
First Name:MARTINA
Middle Name:TERESA
Last Name:YOUNG
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5007 MALLARD CROSSING LN
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45247-8003
Mailing Address - Country:US
Mailing Address - Phone:513-205-1261
Mailing Address - Fax:
Practice Address - Street 1:2335 JOHN GRAY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-1036
Practice Address - Country:US
Practice Address - Phone:513-825-3862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03219492183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist