Provider Demographics
NPI:1508159120
Name:VIDIC, JULENE WHITE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JULENE
Middle Name:WHITE
Last Name:VIDIC
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 1:503 KENSINGTON CT
Mailing Address - Street 2:
Mailing Address - City:MARS
Mailing Address - State:PA
Mailing Address - Zip Code:16046-3140
Mailing Address - Country:US
Mailing Address - Phone:412-874-9839
Mailing Address - Fax:
Practice Address - Street 1:503 KENSINGTON CT
Practice Address - Street 2:
Practice Address - City:MARS
Practice Address - State:PA
Practice Address - Zip Code:16046-3140
Practice Address - Country:US
Practice Address - Phone:412-874-9839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP036188L1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist