Provider Demographics
NPI:1134433683
Name:MAGARDIE, JUANITA VENECIA (PHARMACIST)
Entity type:Individual
Prefix:
First Name:JUANITA
Middle Name:VENECIA
Last Name:MAGARDIE
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:CRESCENT CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95531-2011
Mailing Address - Country:US
Mailing Address - Phone:707-291-7631
Mailing Address - Fax:
Practice Address - Street 1:645 LAKE ST
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95531-2011
Practice Address - Country:US
Practice Address - Phone:707-291-7631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63866183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist