Provider Demographics
NPI:1619151230
Name:BURNS, JULIE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:
Last Name:BURNS
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 1:47 STEWART AVE
Mailing Address - Street 2:POB 146
Mailing Address - City:ROSCOE
Mailing Address - State:NY
Mailing Address - Zip Code:12776-5105
Mailing Address - Country:US
Mailing Address - Phone:607-498-4111
Mailing Address - Fax:607-498-4117
Practice Address - Street 1:POB 146 47 STEWART AVENUE
Practice Address - Street 2:MEDICINE SHOPPE PHARMACY
Practice Address - City:ROSCOE
Practice Address - State:NY
Practice Address - Zip Code:12776
Practice Address - Country:US
Practice Address - Phone:607-498-4111
Practice Address - Fax:607-498-4117
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034797183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY034797Medicaid