Provider Demographics
NPI:1912379496
Name:TSUPRUN, JULIA
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:TSUPRUN
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 1:365 E HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-5820
Mailing Address - Country:US
Mailing Address - Phone:805-374-7551
Mailing Address - Fax:805-374-7419
Practice Address - Street 1:365 E HILLCREST DR
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-5820
Practice Address - Country:US
Practice Address - Phone:805-374-7551
Practice Address - Fax:805-374-7419
Is Sole Proprietor?:No
Enumeration Date:2015-10-23
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56847183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist