Provider Demographics
NPI:1568680809
Name:BOOTH-MORAN, JULIE LYNN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:LYNN
Last Name:BOOTH-MORAN
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 1:7531 MAYO ST
Mailing Address - Street 2:
Mailing Address - City:CENTURY
Mailing Address - State:FL
Mailing Address - Zip Code:32535-2906
Mailing Address - Country:US
Mailing Address - Phone:850-256-3472
Mailing Address - Fax:850-256-3529
Practice Address - Street 1:7531 MAYO ST
Practice Address - Street 2:
Practice Address - City:CENTURY
Practice Address - State:FL
Practice Address - Zip Code:32535-2906
Practice Address - Country:US
Practice Address - Phone:850-256-3472
Practice Address - Fax:850-256-3529
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS20241183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist