=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619261997
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JULIE WILSON UPTON RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2011
-----------------------------------------------------
Last Update Date | 06/04/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1900 MATTHEWS TOWNSHIP PKWY
-----------------------------------------------------
City | MATTHEWS
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28105-4660
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-846-6902
-----------------------------------------------------
Fax | 704-846-6902
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1900 MATTHEWS TOWNSHIP PKWY
-----------------------------------------------------
City | MATTHEWS
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28105-4660
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-846-6902
-----------------------------------------------------
Fax | 704-846-6902
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 15353
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 8146
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------