=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770174898
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JULIET MARIE SMALL PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/01/2021
-----------------------------------------------------
Last Update Date | 02/01/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8335 WESTCHESTER DR
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75225-5716
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-361-7118
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1908 WATER LILY DR
-----------------------------------------------------
City | SOUTHLAKE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76092-5868
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-991-8146
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 38149
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------