Provider Demographics
NPI:1497510663
Name:SHUPP, JULIE (RPH, BCOP)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:
Last Name:SHUPP
Suffix:
Gender:F
Credentials:RPH, BCOP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11110 MEDICAL CAMPUS RD STE 130
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-6799
Mailing Address - Country:US
Mailing Address - Phone:301-790-9214
Mailing Address - Fax:
Practice Address - Street 1:11110 MEDICAL CAMPUS RD STE 130
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-6799
Practice Address - Country:US
Practice Address - Phone:301-790-9214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-16
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD138121835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology