Provider Demographics
NPI:1467638452
Name:STARK, JULIE MARIE (DOCTOR OF PHARMACY)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:MARIE
Last Name:STARK
Suffix:
Gender:F
Credentials:DOCTOR OF PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:13815-1620
Mailing Address - Country:US
Mailing Address - Phone:607-334-2431
Mailing Address - Fax:607-336-2235
Practice Address - Street 1:38 S BROAD ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-1620
Practice Address - Country:US
Practice Address - Phone:607-334-2431
Practice Address - Fax:607-336-2235
Is Sole Proprietor?:No
Enumeration Date:2008-01-21
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051316183500000X
NY051316-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00911431Medicaid
NY1467638452Medicaid