Provider Demographics
NPI:1164242467
Name:YOUNG, BRANDON A
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:A
Last Name:YOUNG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10502 CANARY ISLE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2717
Mailing Address - Country:US
Mailing Address - Phone:917-716-2929
Mailing Address - Fax:
Practice Address - Street 1:16041 TAMPA PALMS BLVD W
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-2001
Practice Address - Country:US
Practice Address - Phone:813-972-2784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-12
Last Update Date:2024-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL67815183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist