Provider Demographics
NPI:1720362130
Name:RANBURGER, JULIE ANN (RPH)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:RANBURGER
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 1:4901 WILSON AVE SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49418-8788
Mailing Address - Country:US
Mailing Address - Phone:616-406-2678
Mailing Address - Fax:616-406-2675
Practice Address - Street 1:4901 WILSON AVE SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49418-8788
Practice Address - Country:US
Practice Address - Phone:616-406-2678
Practice Address - Fax:616-406-2675
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302031798183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist