Active NPI
Moderne Young, PHARMD
- Pharmacist
- Corona, CA
National Provider Identifier
1003137159
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 57856
- Practice address
- 2055 Kellogg Ave
Corona, CA 92879-3111 - Phone
- (951) 898-7106
- NPI assigned
- Jun 11, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 57856 | CA | Primary |
Addresses
Primary practice location
2055 Kellogg Ave
Corona, CA 92879-3111
Mailing address
2055 Kellogg Ave
Corona, CA 95879
Phone (951) 898-7106
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 57856 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1276214400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1003137159",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2055 KELLOGG AVE",
"city": "CORONA",
"state": "CA",
"postal_code": "95879",
"telephone_number": "951-898-7106"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2055 KELLOGG AVE",
"city": "CORONA",
"state": "CA",
"postal_code": "928793111",
"telephone_number": "951-898-7106"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YOUNG",
"first_name": "MODERNE",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-06-11",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "57856",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Corona, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.