Provider Demographics
NPI:1871880997
Name:MCDOUGLE, JULIE LYNN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:LYNN
Last Name:MCDOUGLE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5455 BIG TYLER RD STE F
Mailing Address - Street 2:
Mailing Address - City:CROSS LANES
Mailing Address - State:WV
Mailing Address - Zip Code:25313-1193
Mailing Address - Country:US
Mailing Address - Phone:304-204-0060
Mailing Address - Fax:304-204-0064
Practice Address - Street 1:5455 BIG TYLER RD STE F
Practice Address - Street 2:
Practice Address - City:CROSS LANES
Practice Address - State:WV
Practice Address - Zip Code:25313-1193
Practice Address - Country:US
Practice Address - Phone:304-204-0060
Practice Address - Fax:304-204-0064
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-10
Last Update Date:2011-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0007475183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist