Youngblood, James L

Youngblood, James L is an sole proprietor health care provider with primary practice located at 2711 Corner Ct , Alton IL 62002-5328. He recently has only one registered license in Suppliers / Pharmacy, which is considered as his primary health care specialty. Youngblood, James L can be contacted via phone (618) 462-0052.

Contact Information

Primary practice address
2711 Corner Ct Alton IL 62002-5328
Phone: (618) 462-0052
Fax: (618) 462-8114
Website:
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Health care specialties

SpecialtyCodeLicense #State
Suppliers / Pharmacy 333600000X 545740 Illinois

Profile Details

NPI number 1487707824
LBN Legal business name Youngblood, James L
Credentials RPH
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jan 19th, 2007
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1487707824 NPPES
Illinois MEDICAID 371000048001

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