Provider Demographics
NPI:1104489855
Name:CROCFER, JULIE KAY (RPH)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:KAY
Last Name:CROCFER
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 1:6310 S US HIGHWAY 85-87
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN
Mailing Address - State:CO
Mailing Address - Zip Code:80817-1006
Mailing Address - Country:US
Mailing Address - Phone:719-391-1505
Mailing Address - Fax:719-390-8987
Practice Address - Street 1:6310 S US HIGHWAY 85-87
Practice Address - Street 2:
Practice Address - City:FOUNTAIN
Practice Address - State:CO
Practice Address - Zip Code:80817-1006
Practice Address - Country:US
Practice Address - Phone:719-391-1505
Practice Address - Fax:719-390-8987
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15716183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist