Provider Demographics
NPI:1043364953
Name:POVLICK, JULIE A (PHARMD, CDM)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:A
Last Name:POVLICK
Suffix:
Gender:F
Credentials:PHARMD, CDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 TADSWORTH TER
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-5336
Mailing Address - Country:US
Mailing Address - Phone:407-710-3029
Mailing Address - Fax:
Practice Address - Street 1:2381 W STATE ROAD 434
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-4984
Practice Address - Country:US
Practice Address - Phone:407-869-4973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS41098183500000X
IA19345183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist