Provider Demographics
NPI:1851375356
Name:REVES, JULIE E (DPH)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:E
Last Name:REVES
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 HOLLY HILL DR
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-2362
Mailing Address - Country:US
Mailing Address - Phone:865-660-8753
Mailing Address - Fax:
Practice Address - Street 1:702 W MAIN ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-3734
Practice Address - Country:US
Practice Address - Phone:662-840-4818
Practice Address - Fax:662-840-4816
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-09108183500000X
TN10119183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1851375356OtherPHARMACIST