Active NPI
Kelly Young
- Pharmacist
- Fontana, CA
National Provider Identifier
1508411539
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 78268
- Practice address
- 11121 Sierra Ave
Fontana, CA 92337-9310 - Phone
- (909) 356-9715
- NPI assigned
- Aug 6, 2019
- Last updated
- May 4, 2023
- 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 | 78268 | CA | Primary |
Addresses
Primary practice location
11121 Sierra Ave
Fontana, CA 92337-9310
Mailing address
11121 Sierra Ave
Fontana, CA 92337-9310
Phone (909) 356-9715
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 78268 | CA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Current | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients | |
| Garfield Beach CVS, L.L.C. | Past | Accepting new patients | |
| Garfield Beach CVS LLC | Past | Accepting new patients |
Locations
11121 Sierra Ave
Fontana, CA 92337
Phone (909) 356-9715
Interoperability endpoints
- kelly.young.p1@direct.chsica.nextgenshare.com
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1565049600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1683158400000",
"number": "1508411539",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11121 SIERRA AVE",
"city": "FONTANA",
"state": "CA",
"postal_code": "923379310",
"telephone_number": "909-356-9715"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11121 SIERRA AVE",
"city": "FONTANA",
"state": "CA",
"postal_code": "923379310",
"telephone_number": "909-356-9715"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YOUNG",
"first_name": "KELLY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-08-06",
"last_updated": "2023-05-04",
"certification_date": "2023-05-01",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "78268",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fontana, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.