Healthcare Provider Details

I. General information

NPI: 1477155752
Provider Name (Legal Business Name): JULIE HEFNER RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2020
Last Update Date: 11/12/2020
Certification Date: 11/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15017 EMERALD COAST PKWY
DESTIN FL
32541-3358
US

IV. Provider business mailing address

328 TRADEWINDS DR
SANTA ROSA BEACH FL
32459-8102
US

V. Phone/Fax

Practice location:
  • Phone: 850-654-1502
  • Fax:
Mailing address:
  • Phone: 615-804-5960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS50166
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: