Provider Demographics
NPI:1164595625
Name:FERNANDO, JULIUS SANTOS (RPH)
Entity Type:Individual
Prefix:
First Name:JULIUS
Middle Name:SANTOS
Last Name:FERNANDO
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:PO BOX 315363
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96931-3263
Mailing Address - Country:US
Mailing Address - Phone:671-646-6395
Mailing Address - Fax:671-646-4332
Practice Address - Street 1:416 CHALAN SAN ANTONIO
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-3601
Practice Address - Country:US
Practice Address - Phone:671-649-1977
Practice Address - Fax:671-646-4332
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUPH-0106183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist