MEDICARE: MRS. GILDA-JO YOUNGBLOOD RPH

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	PS0015060	FL

General Provider Information

NPI Number	:	1619070844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GILDA-JO YOUNGBLOOD RPH

Provider Business Mailing Address
First Line	:	1342 SW 44TH TER
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33442-8261
Country	:	US
Telephone Number	:	954-574-0214
Fax Number	:

Provider Business Practice Location Address
First Line	:	1101 S MILITARY TRL
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33442-7645
Country	:	US
Telephone Number	:	954-421-5358
Fax Number	:	954-421-2347

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

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	07/08/2007

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