Provider Demographics
NPI:1417237140
Name:SZYMCZAK, JULIE LYNNE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:LYNNE
Last Name:SZYMCZAK
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 1:100 S RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-4316
Mailing Address - Country:US
Mailing Address - Phone:386-255-4167
Mailing Address - Fax:386-255-4793
Practice Address - Street 1:100 S RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-4316
Practice Address - Country:US
Practice Address - Phone:386-255-4167
Practice Address - Fax:386-255-4793
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS22971183500000X
IL051036409183500000X
MO041992183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist