Healthcare Provider Details

I. General information

NPI: 1366866972
Provider Name (Legal Business Name): JULIE ANN NIEWOEHNER PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIE ANN NELSON PHARM.D.

II. Dates (important events)

Enumeration Date: 02/18/2014
Last Update Date: 09/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 MASSACHUSETTS ST
LAWRENCE KS
66046
US

IV. Provider business mailing address

2415 MASSACHUSETTS ST
LAWRENCE KS
66046-4808
US

V. Phone/Fax

Practice location:
  • Phone: 785-832-4818
  • Fax: 785-832-4878
Mailing address:
  • Phone: 785-832-4818
  • Fax: 785-832-4878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number6064
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number17250
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: