Provider Demographics
NPI:1831426634
Name:YOUNGBLOOD, XOA T (PHARM D)
Entity type:Individual
Prefix:DR
First Name:XOA
Middle Name:T
Last Name:YOUNGBLOOD
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:DR
Other - First Name:XOA
Other - Middle Name:T
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:16601 E CENTRETECH PKWY
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-9045
Mailing Address - Country:US
Mailing Address - Phone:303-739-4936
Mailing Address - Fax:303-739-4927
Practice Address - Street 1:16601 E CENTRETECH PKWY
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-9045
Practice Address - Country:US
Practice Address - Phone:303-739-4936
Practice Address - Fax:303-739-4936
Is Sole Proprietor?:No
Enumeration Date:2009-11-16
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO18109183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO015545OtherKAISER