Provider Demographics
NPI:1699069062
Name:YOUNG, LYNN R (RPH)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:R
Last Name:YOUNG
Suffix:
Gender:F
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:PO BOX 6146
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56302-6146
Mailing Address - Country:US
Mailing Address - Phone:320-252-4222
Mailing Address - Fax:320-203-1095
Practice Address - Street 1:1921 COBORN BLVD
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-2100
Practice Address - Country:US
Practice Address - Phone:320-252-4222
Practice Address - Fax:320-203-1095
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-02
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN114997183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist