Provider Demographics
NPI:1437170925
Name:KANE, JULIE MARIE (RPH)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:MARIE
Last Name:KANE
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 1:211 SW WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-3037
Mailing Address - Country:US
Mailing Address - Phone:515-963-1640
Mailing Address - Fax:515-963-7752
Practice Address - Street 1:211 SW WALNUT ST
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-3037
Practice Address - Country:US
Practice Address - Phone:515-963-1640
Practice Address - Fax:515-963-7752
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18876183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist