Provider Demographics
NPI:1235461443
Name:WADSWORTH, JULIET M (RPH)
Entity Type:Individual
Prefix:MS
First Name:JULIET
Middle Name:M
Last Name:WADSWORTH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 TOWN AND COUNTRY DR
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-3962
Mailing Address - Country:US
Mailing Address - Phone:386-325-7562
Mailing Address - Fax:386-326-0281
Practice Address - Street 1:111 TOWN AND COUNTRY DR
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-3962
Practice Address - Country:US
Practice Address - Phone:386-325-7562
Practice Address - Fax:386-326-0281
Is Sole Proprietor?:No
Enumeration Date:2010-02-12
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS22577183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist