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General NPI Number Information
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NPI Number | 1407974884
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Entity Type | Individual
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Provider Name | WILTON EARL YOUNGBLOOD RPH
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Gender | Male
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1107 E 42ND ST
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City | ODESSA
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State | TX
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Zip | 79762
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Country | US
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Telephone | 432-367-3407
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Fax | 432-366-0336
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Provider Business Mailing Address
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Address Line | 4515 ROBIN LANE
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City | MIDLAND
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State | TX
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Zip | 79707
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Country | US
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Telephone | 432-367-3407
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Fax | 432-366-0336
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 19722
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License Number State | TX
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