Provider Demographics
NPI:1518969310
Name:HAZEL, JULIE ANN (RPH)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:HAZEL
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 1:267 NE HILLCREST ST
Mailing Address - Street 2:
Mailing Address - City:MADRAS
Mailing Address - State:OR
Mailing Address - Zip Code:97741-2640
Mailing Address - Country:US
Mailing Address - Phone:541-475-3968
Mailing Address - Fax:
Practice Address - Street 1:1270 KOT-NUM RD
Practice Address - Street 2:
Practice Address - City:WARM SPRINGS
Practice Address - State:OR
Practice Address - Zip Code:97761
Practice Address - Country:US
Practice Address - Phone:541-553-2134
Practice Address - Fax:541-553-2481
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22798183500000X
IN26019100A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA22798OtherPHARMACIST REGISTRATION
IN26019100AOtherPHARMACY LICENSE