Provider Demographics
NPI:1972884484
Name:RESER, JULIE
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:RESER
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 1:1285 N MONROE ST
Mailing Address - Street 2:WALGREENS #2023
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-3115
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1285 N MONROE ST
Practice Address - Street 2:WALGREENS #2023
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-3115
Practice Address - Country:US
Practice Address - Phone:734-457-2336
Practice Address - Fax:734-457-5961
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302040549183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist