Provider Demographics
NPI:1609188135
Name:MAIN, JULIA (PHARM D, RPH)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:MAIN
Suffix:
Gender:F
Credentials:PHARM D, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 PRAIRIE ST N
Mailing Address - Street 2:
Mailing Address - City:UNION SPRINGS
Mailing Address - State:AL
Mailing Address - Zip Code:36089-1417
Mailing Address - Country:US
Mailing Address - Phone:334-738-2020
Mailing Address - Fax:334-738-8050
Practice Address - Street 1:302 PRAIRIE ST N
Practice Address - Street 2:
Practice Address - City:UNION SPRINGS
Practice Address - State:AL
Practice Address - Zip Code:36089-1417
Practice Address - Country:US
Practice Address - Phone:334-738-2020
Practice Address - Fax:334-738-8050
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15826183500000X, 1835G0303X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist