Healthcare Provider Details

I. General information

NPI: 1477982437
Provider Name (Legal Business Name): JULIE PHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2013
Last Update Date: 11/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 US HIGHWAY 1 S
SAINT AUGUSTINE FL
32084-4211
US

IV. Provider business mailing address

9734 TAPESTRY PARK CIR APT 456
JACKSONVILLE FL
32246-9944
US

V. Phone/Fax

Practice location:
  • Phone: 904-824-7127
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS51315
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: