Provider Demographics
NPI:1609278555
Name:KERTIS, JULIE MICHELLE (PHARM D)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:MICHELLE
Last Name:KERTIS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10050 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-8436
Mailing Address - Country:US
Mailing Address - Phone:919-596-6821
Mailing Address - Fax:
Practice Address - Street 1:10050 GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-8436
Practice Address - Country:US
Practice Address - Phone:919-596-6821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23176183500000X
FLPS37957183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist