Provider Demographics
NPI:1003365453
Name:LA JUNE, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:LA JUNE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 R ST
Mailing Address - Street 2:3061 COPPERTREE COURT
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-5850
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1445 R ST
Practice Address - Street 2:3061 COPPERTREE COURT
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-5850
Practice Address - Country:US
Practice Address - Phone:209-725-5030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-27
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28432183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist