Healthcare Provider Details

I. General information

NPI: 1982930632
Provider Name (Legal Business Name): JULIE WILSON CALDWELL RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2009
Last Update Date: 12/27/2022
Certification Date: 12/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WILMOT RD
DEERFIELD IL
60015-4681
US

IV. Provider business mailing address

4040 MONROE DR
MIDLOTHIAN TX
76065-3784
US

V. Phone/Fax

Practice location:
  • Phone: 972-268-5092
  • Fax:
Mailing address:
  • Phone: 972-268-5092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number34910
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: