Provider Demographics
NPI:1972898526
Name:LARUE, JULIE ANN (RPH)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:LARUE
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 1:21001 N TATUM BLVD STE 20
Mailing Address - Street 2:T-1360
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-4207
Mailing Address - Country:US
Mailing Address - Phone:480-419-9670
Mailing Address - Fax:480-419-9670
Practice Address - Street 1:21001 N TATUM BLVD STE 20
Practice Address - Street 2:T-1360
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-4207
Practice Address - Country:US
Practice Address - Phone:480-419-9670
Practice Address - Fax:480-419-9670
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-11
Last Update Date:2011-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS008655183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist