Healthcare Provider Details

I. General information

NPI: 1649768136
Provider Name (Legal Business Name): JULIE MARVIN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2018
Last Update Date: 05/16/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1903 E 9TH ST
TRENTON MO
64683-2645
US

IV. Provider business mailing address

1903 E 9TH ST
TRENTON MO
64683-2645
US

V. Phone/Fax

Practice location:
  • Phone: 660-359-5700
  • Fax: 660-359-5701
Mailing address:
  • Phone: 660-707-3539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1-15673
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2002028995
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: