Provider Demographics
NPI:1083290795
Name:BOUCHER, JULIE L (PHARMD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:L
Last Name:BOUCHER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:L
Other - Last Name:SCHEARS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:55 PARK ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-5474
Mailing Address - Country:US
Mailing Address - Phone:203-688-3861
Mailing Address - Fax:
Practice Address - Street 1:55 PARK ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5474
Practice Address - Country:US
Practice Address - Phone:203-688-3861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18875-401835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist