Provider Demographics
NPI:1851766091
Name:EMMICK, JULIE (RPH)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:EMMICK
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 1:4195 BRAEBURN DR
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49441-4628
Mailing Address - Country:US
Mailing Address - Phone:616-402-2212
Mailing Address - Fax:
Practice Address - Street 1:1879 E SHERMAN BLVD
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-1858
Practice Address - Country:US
Practice Address - Phone:231-739-5519
Practice Address - Fax:231-739-5328
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-13
Last Update Date:2015-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302032667183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist