Provider Demographics
NPI:1902352214
Name:YOUNG, LABAN EUGENE (RPH)
Entity Type:Individual
Prefix:MR
First Name:LABAN
Middle Name:EUGENE
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:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:LOUISA
Mailing Address - State:KY
Mailing Address - Zip Code:41230-0069
Mailing Address - Country:US
Mailing Address - Phone:606-793-4113
Mailing Address - Fax:606-638-1109
Practice Address - Street 1:408 N LOCK AVE
Practice Address - Street 2:
Practice Address - City:LOUISA
Practice Address - State:KY
Practice Address - Zip Code:41230-1115
Practice Address - Country:US
Practice Address - Phone:606-638-4155
Practice Address - Fax:606-638-1109
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-27
Last Update Date:2016-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY008058183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist