MEDICARE: JULIA DOHERTY

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
1	183500000X	Pharmacist	22082	AL
2	390200000X	Student in an Organized Health Care Education/Training Program	S12319	AL

General Provider Information

NPI Number	:	1962976415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIA DOHERTY

Provider Business Mailing Address
First Line	:	1207 TUNLAW RD SE
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35801-2514
Country	:	US
Telephone Number	:	256-606-7235
Fax Number	:

Provider Business Practice Location Address
First Line	:	310 PELHAM AVE SW
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35801-5016
Country	:	US
Telephone Number	:	256-606-7235
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2019
Last Update Date	:	09/03/2021

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Directions to “ JULIA DOHERTY ” Practice Location

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