Provider Demographics
NPI:1497350763
Name:YOUNGBLOOD, JULIE BOWE
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:BOWE
Last Name:YOUNGBLOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 N POTAGE ST
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44230
Mailing Address - Country:US
Mailing Address - Phone:330-658-2711
Mailing Address - Fax:
Practice Address - Street 1:105 N PORTAGE ST
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:OH
Practice Address - Zip Code:44230-1368
Practice Address - Country:US
Practice Address - Phone:330-658-2711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03321714183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist