Provider Demographics
NPI:1649592015
Name:BICKERS, JULIE D (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:D
Last Name:BICKERS
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 1:1517 BEAVER LAKE CT.
Mailing Address - Street 2:
Mailing Address - City:MAHOMET
Mailing Address - State:IL
Mailing Address - Zip Code:61853
Mailing Address - Country:US
Mailing Address - Phone:217-590-4664
Mailing Address - Fax:
Practice Address - Street 1:3114 VILLAGE OFFICE PL
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822-7680
Practice Address - Country:US
Practice Address - Phone:217-378-4807
Practice Address - Fax:217-378-4932
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-290449183500000X
IN26019201A183500000X
OHRPH.03223536-2183500000X
MO200303034183500000X
KS1-13713183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist