Provider Demographics
NPI:1063057529
Name:PHILLIPS, JULIE
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1594 TUSCANY COVE DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-2049
Mailing Address - Country:US
Mailing Address - Phone:801-726-0654
Mailing Address - Fax:
Practice Address - Street 1:1316 N HIGHWAY 89
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-3841
Practice Address - Country:US
Practice Address - Phone:801-451-2900
Practice Address - Fax:801-451-7607
Is Sole Proprietor?:No
Enumeration Date:2019-11-08
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT260332-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist