Provider Demographics
NPI:1841895695
Name:SMITH, JULIE (PHARMACIST)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHATMACIST
Mailing Address - Street 1:1901 S 25TH E
Mailing Address - Street 2:
Mailing Address - City:AMMON
Mailing Address - State:ID
Mailing Address - Zip Code:83406-5710
Mailing Address - Country:US
Mailing Address - Phone:208-524-1616
Mailing Address - Fax:
Practice Address - Street 1:1901 S 25TH E
Practice Address - Street 2:
Practice Address - City:AMMON
Practice Address - State:ID
Practice Address - Zip Code:83406-5710
Practice Address - Country:US
Practice Address - Phone:208-524-1616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP8746183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist