Provider Demographics
NPI:1447567524
Name:TAH, JULIUS MBONI (PHARMD)
Entity Type:Individual
Prefix:
First Name:JULIUS
Middle Name:MBONI
Last Name:TAH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8412 RIVER WALK CT
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-6941
Mailing Address - Country:US
Mailing Address - Phone:704-256-9067
Mailing Address - Fax:336-633-7608
Practice Address - Street 1:207 N FAYETTEVILLE ST
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-5529
Practice Address - Country:US
Practice Address - Phone:336-633-7611
Practice Address - Fax:336-633-7608
Is Sole Proprietor?:No
Enumeration Date:2010-09-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT178317863183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist