Provider Demographics
NPI:1336418052
Name:YOUNG, DIANA KWEILING
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:KWEILING
Last Name:YOUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 COUNTRY CLUB DR APT 4505
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-2181
Mailing Address - Country:US
Mailing Address - Phone:727-249-4200
Mailing Address - Fax:
Practice Address - Street 1:3851 4TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703-6114
Practice Address - Country:US
Practice Address - Phone:727-822-6896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-27
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS36857183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist