Provider Demographics
NPI:1871878850
Name:ANDERSON, JULIE A (RPH)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:A
Last Name:ANDERSON
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 1:10396 BOUNDARY CREEK TER
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-2841
Mailing Address - Country:US
Mailing Address - Phone:763-493-3577
Mailing Address - Fax:
Practice Address - Street 1:11401 MARKETPLACE DR N
Practice Address - Street 2:
Practice Address - City:CHAMPLIN
Practice Address - State:MN
Practice Address - Zip Code:55316-3794
Practice Address - Country:US
Practice Address - Phone:763-427-6389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN114556183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist