Provider Demographics
NPI:1093039117
Name:JULIANO, JERRY FRANK (RPH)
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:FRANK
Last Name:JULIANO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5760 N. CHIEFTAN TRAIL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85750-1303
Mailing Address - Country:US
Mailing Address - Phone:520-577-7572
Mailing Address - Fax:
Practice Address - Street 1:5760 N. CHIEFTAN TRAIL
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85750-1303
Practice Address - Country:US
Practice Address - Phone:520-577-7572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6502183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist