Provider Demographics
NPI:1356611867
Name:YOUNGBLOOD, BHAIRAVI (RPH)
Entity type:Individual
Prefix:MS
First Name:BHAIRAVI
Middle Name:
Last Name:YOUNGBLOOD
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:BHAIRAVI
Other - Middle Name:
Other - Last Name:YOUNGBLOOD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:950 IMMOKALEE RD
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-4800
Mailing Address - Country:US
Mailing Address - Phone:239-514-2049
Mailing Address - Fax:239-514-3549
Practice Address - Street 1:950 IMMOKALEE RD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-4800
Practice Address - Country:US
Practice Address - Phone:239-514-2049
Practice Address - Fax:239-514-3549
Is Sole Proprietor?:No
Enumeration Date:2012-01-01
Last Update Date:2012-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0038498183500000X
MD13478183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS0038948OtherSTATE BOARD OF FLORIDA REGISTERED PHARMACIST LICENSE