Healthcare Provider Details

I. General information

NPI: 1366425712
Provider Name (Legal Business Name): JULIE ANNA KING PHARMD, RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIE ANNA TENNENHOUSE PHARMD

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SAN FELIPE HEALTH CLINIC PHARMACY CEDAR STREET #4 SAN FELIPE PUEBLO
SAN FELIPE NM
87001
US

IV. Provider business mailing address

5 CAMINO DE LA QUESTA DEL AIRE
PLACITAS NM
87043-8837
US

V. Phone/Fax

Practice location:
  • Phone: 505-867-2739
  • Fax: 505-867-6527
Mailing address:
  • Phone: 505-867-2739
  • Fax: 505-867-6527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00005733
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: