Provider Demographics
NPI:1447374376
Name:POWELL, JUNE MARIE (RPH)
Entity type:Individual
Prefix:MRS
First Name:JUNE
Middle Name:MARIE
Last Name:POWELL
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 1:5401 N MURPHY RD
Mailing Address - Street 2:
Mailing Address - City:BRAZIL
Mailing Address - State:IN
Mailing Address - Zip Code:47834-8236
Mailing Address - Country:US
Mailing Address - Phone:812-446-0314
Mailing Address - Fax:
Practice Address - Street 1:2150 E NATIONAL AVE
Practice Address - Street 2:WAL-MART PHARMACY
Practice Address - City:BRAZIL
Practice Address - State:IN
Practice Address - Zip Code:47834-2831
Practice Address - Country:US
Practice Address - Phone:812-443-0466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26016316A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist