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General NPI Number Information
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NPI Number | 1932796059
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Entity Type | Individual
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Provider Name | JULIE ROUSE RPH
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Gender | Female
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Dates
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Enumeration Date | 12/22/2020
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Last Update Date | 12/22/2020
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Provider Practice Location Address
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Address Line | 5524 W CERMAK RD
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City | CICERO
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State | IL
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Zip | 60804-2217
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Country | US
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Telephone | 708-656-0306
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Fax |
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Provider Business Mailing Address
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Address Line | 1800 W ROSCOE ST APT 220
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City | CHICAGO
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State | IL
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Zip | 60657-1072
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Country | US
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Telephone | 773-320-3253
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 051287127
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License Number State | IL
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