Provider Demographics
NPI:1699876805
Name:YOUNG, JAMES NICHOLAS III (RPH)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:NICHOLAS
Last Name:YOUNG
Suffix:III
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:310 SHERMAN DR
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49068-9616
Mailing Address - Country:US
Mailing Address - Phone:269-781-5203
Mailing Address - Fax:
Practice Address - Street 1:120 S CLARK ST
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:MI
Practice Address - Zip Code:49224-1915
Practice Address - Country:US
Practice Address - Phone:517-629-2900
Practice Address - Fax:517-629-7820
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302020385183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302020385OtherREGISTERED PHARMACIST