Provider Demographics
NPI:1790079788
Name:REINECK, JULIE MARIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:MARIE
Last Name:REINECK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:MARIE
Other - Last Name:PASS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4689 SHORELINE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SPRING PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55384-9715
Mailing Address - Country:US
Mailing Address - Phone:952-471-3784
Mailing Address - Fax:952-471-1212
Practice Address - Street 1:4689 SHORELINE DR STE 100
Practice Address - Street 2:
Practice Address - City:SPRING PARK
Practice Address - State:MN
Practice Address - Zip Code:55384-9715
Practice Address - Country:US
Practice Address - Phone:952-471-3784
Practice Address - Fax:952-471-1212
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN118552183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist