Provider Demographics
NPI:1437579224
Name:ETTERS, JULIE
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:ETTERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3040 S SHORE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-5601
Mailing Address - Country:US
Mailing Address - Phone:843-532-7667
Mailing Address - Fax:
Practice Address - Street 1:1231 FOLLY RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-4105
Practice Address - Country:US
Practice Address - Phone:843-762-9047
Practice Address - Fax:843-762-4959
Is Sole Proprietor?:No
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9927183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist