Provider Demographics
NPI:1619070844
Name:YOUNGBLOOD, GILDA-JO (RPH)
Entity Type:Individual
Prefix:MRS
First Name:GILDA-JO
Middle Name:
Last Name:YOUNGBLOOD
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1342 SW 44TH TER
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-8261
Mailing Address - Country:US
Mailing Address - Phone:954-574-0214
Mailing Address - Fax:
Practice Address - Street 1:1101 S MILITARY TRL
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-7645
Practice Address - Country:US
Practice Address - Phone:954-421-5358
Practice Address - Fax:954-421-2347
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0015060183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist