Provider Demographics
NPI:1689068223
Name:PETERSON, JULIE ANN (PHARMD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:PETERSON
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 1:8001 LINCOLN AVE STE 800
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-3657
Mailing Address - Country:US
Mailing Address - Phone:800-553-7359
Mailing Address - Fax:
Practice Address - Street 1:8001 LINCOLN AVE STE 800
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-3657
Practice Address - Country:US
Practice Address - Phone:800-553-7359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-20
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN116306183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist