Provider Demographics
NPI:1770174898
Name:SMALL, JULIET MARIE (PHARMD)
Entity type:Individual
Prefix:
First Name:JULIET
Middle Name:MARIE
Last Name:SMALL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 WATER LILY DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-5868
Mailing Address - Country:US
Mailing Address - Phone:817-991-8146
Mailing Address - Fax:
Practice Address - Street 1:8335 WESTCHESTER DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-5716
Practice Address - Country:US
Practice Address - Phone:214-361-7118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38149183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist