Provider Demographics
NPI:1598734576
Name:TENNIN, JULIA C (PHARMD)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:C
Last Name:TENNIN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1883 HWY 43 SOUTH
Mailing Address - Street 2:SUITE A
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046
Mailing Address - Country:US
Mailing Address - Phone:601-407-1440
Mailing Address - Fax:601-407-1441
Practice Address - Street 1:1883 HIGHWAY 43 S
Practice Address - Street 2:SUITE A
Practice Address - City:CANTON
Practice Address - State:MS
Practice Address - Zip Code:39046-8405
Practice Address - Country:US
Practice Address - Phone:601-407-1440
Practice Address - Fax:601-407-1441
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE7245183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSE7245OtherPHARMACY LICENSE NUMBER