Provider Demographics
NPI:1184345415
Name:YOUNGBLOOD, SHELBY (PHARMD)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:YOUNGBLOOD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2312 W FOOTHILLS DR APT 1
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59803-2661
Mailing Address - Country:US
Mailing Address - Phone:605-939-6632
Mailing Address - Fax:
Practice Address - Street 1:1902 BROOKS ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-6644
Practice Address - Country:US
Practice Address - Phone:406-728-1380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPHA-PHA-LIC-88840183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist