Healthcare Provider Details

I. General information

NPI: 1346887114
Provider Name (Legal Business Name): JULIE BARBARA RYCKMAN PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2019
Last Update Date: 11/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33523 8 MILE RD
LIVONIA MI
48152-4117
US

IV. Provider business mailing address

33523 8 MILE RD
LIVONIA MI
48152-4117
US

V. Phone/Fax

Practice location:
  • Phone: 248-473-8240
  • Fax: 248-474-9810
Mailing address:
  • Phone: 248-473-8240
  • Fax: 248-474-9810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302038272
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number5302038272
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: