Provider Demographics
NPI:1306954706
Name:YOUNG, RANDALL THEODORE (RPH)
Entity type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:THEODORE
Last Name:YOUNG
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1571 KY HIGHWAY 259 N
Mailing Address - Street 2:PO BOX 540
Mailing Address - City:BROWNSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42210-9206
Mailing Address - Country:US
Mailing Address - Phone:270-597-9514
Mailing Address - Fax:270-597-3232
Practice Address - Street 1:1571 KY HIGHWAY 259 N
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42210-9206
Practice Address - Country:US
Practice Address - Phone:270-597-9514
Practice Address - Fax:270-597-3232
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY011609183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist