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NPI Code Detail

MEDICARE: JULIE DETERRA

MEDICARE: JULIE DETERRA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist22294MA

General Provider Information

NPI Number : 1225311335
Entity Type Code : Individual
Provider Name (Legal Business Name) : JULIE DETERRA
Provider Business Mailing Address
First Line : 1103 KEMPTON ST
Second Line :
City : NEW BEDFORD
State : MA
Zip : 02740-1530
Country : US
Telephone Number : 508-990-3765
Fax Number :
Provider Business Practice Location Address
First Line : 1103 KEMPTON ST
Second Line :
City : NEW BEDFORD
State : MA
Zip : 02740-1530
Country : US
Telephone Number : 508-990-3765
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/25/2011
Last Update Date : 09/25/2011

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Directions to “ JULIE DETERRA ” Practice Location

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