Provider Demographics
NPI:1235457847
Name:YOUNGBLOOD, JOHN D (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:YOUNGBLOOD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7565 WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-1442
Mailing Address - Country:US
Mailing Address - Phone:330-342-0398
Mailing Address - Fax:
Practice Address - Street 1:7565 WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-1442
Practice Address - Country:US
Practice Address - Phone:330-342-0398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-06
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03221077183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist