Provider Demographics
NPI:1336487362
Name:JUNEAU, VICTORIA REANNON
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:REANNON
Last Name:JUNEAU
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:VICTORIA
Other - Middle Name:REANNON
Other - Last Name:ELLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1157 N EOLA RD
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60502-7006
Mailing Address - Country:US
Mailing Address - Phone:630-851-4657
Mailing Address - Fax:630-851-5567
Practice Address - Street 1:1157 N EOLA RD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60502-7006
Practice Address - Country:US
Practice Address - Phone:630-851-4657
Practice Address - Fax:630-851-5567
Is Sole Proprietor?:No
Enumeration Date:2013-01-25
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL049.182672183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician