Provider Demographics
NPI:1679110308
Name:SMITH, JULIE ANN (RPH)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:SMITH
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 1:17755 MEDDLER AVE
Mailing Address - Street 2:
Mailing Address - City:SAND LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49343-9560
Mailing Address - Country:US
Mailing Address - Phone:616-439-8374
Mailing Address - Fax:
Practice Address - Street 1:9695 N GREENVILLE ROAD
Practice Address - Street 2:
Practice Address - City:LAKEVIEW
Practice Address - State:MI
Practice Address - Zip Code:48850
Practice Address - Country:US
Practice Address - Phone:989-352-8168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-02
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302028385183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist