MEDICARE: RICHARD ALLEN YOUNGBERG R.PH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	051286971	IL

General Provider Information

NPI Number	:	1104093046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD ALLEN YOUNGBERG R.PH.

Provider Business Mailing Address
First Line	:	PO BOX 840688
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-0688
Country	:	US
Telephone Number	:	800-225-5967
Fax Number	:	909-799-4364

Provider Business Practice Location Address
First Line	:	800 BIERMANN CT
Second Line	:	SUITE B
City	:	MT PROSPECT
State	:	IL
Zip	:	60056-2151
Country	:	US
Telephone Number	:	800-225-5967
Fax Number	:	909-799-4364

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2008
Last Update Date	:	05/09/2008

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