MEDICARE: JULIE GARDNER RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	13822	NC

General Provider Information

NPI Number	:	1760753438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE GARDNER RPH

Provider Business Mailing Address
First Line	:	6140 FALLS OF NEUSE RD
Second Line	:	KERR DRUG 419
City	:	RALEIGH
State	:	NC
Zip	:	27609-3528
Country	:	US
Telephone Number	:	919-876-7283
Fax Number	:

Provider Business Practice Location Address
First Line	:	6140 FALLS OF NEUSE RD
Second Line	:	KERR DRUG 419
City	:	RALEIGH
State	:	NC
Zip	:	27609-3528
Country	:	US
Telephone Number	:	919-876-7283
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2012
Last Update Date	:	01/26/2012

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