Provider Demographics
NPI:1326554460
Name:YOUNGE, JEWEL SOPHIA (MA, MAT, PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:JEWEL
Middle Name:SOPHIA
Last Name:YOUNGE
Suffix:
Gender:M
Credentials:MA, MAT, PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5208 S DREXEL AVE APT 2W
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-3722
Mailing Address - Country:US
Mailing Address - Phone:312-218-6808
Mailing Address - Fax:
Practice Address - Street 1:10900 S DOTY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-3804
Practice Address - Country:US
Practice Address - Phone:773-344-9061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-27
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051300661183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL051300661OtherSTATE LICENSE NUMBER