Provider Demographics
NPI:1710434014
Name:MBABAZI, JULIET
Entity Type:Individual
Prefix:
First Name:JULIET
Middle Name:
Last Name:MBABAZI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:494 NUTT RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-3354
Mailing Address - Country:US
Mailing Address - Phone:610-933-2798
Mailing Address - Fax:610-935-1432
Practice Address - Street 1:250 BEVERLY BLVD APT G16
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-4536
Practice Address - Country:US
Practice Address - Phone:484-684-8357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-02
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP439700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP439700OtherPHARMACY