Provider Demographics
NPI:1477162691
Name:SONNENBURG, JULIAN THOMAS
Entity Type:Individual
Prefix:
First Name:JULIAN
Middle Name:THOMAS
Last Name:SONNENBURG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3167 JUNIPER RDG APT 4
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-5779
Mailing Address - Country:US
Mailing Address - Phone:541-610-5119
Mailing Address - Fax:
Practice Address - Street 1:2424 CRATER LAKE HWY
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-4181
Practice Address - Country:US
Practice Address - Phone:541-734-2133
Practice Address - Fax:541-734-2127
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-00179321835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist