Provider Demographics
NPI:1518247287
Name:QUINN, JULIE MOON (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:MOON
Last Name:QUINN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:JULIE
Other - Middle Name:HEATHER
Other - Last Name:MOON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:114 WALDEMAR CT SE
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33884-3804
Mailing Address - Country:US
Mailing Address - Phone:863-875-0626
Mailing Address - Fax:
Practice Address - Street 1:114 WALDEMAR CT SE
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33884-3804
Practice Address - Country:US
Practice Address - Phone:863-875-0626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0029466183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS0029466OtherFLORIDA BOARD OF PHARMACY