Provider Demographics
NPI:1124249545
Name:BALLIET, JULIE KAY (RPH)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:KAY
Last Name:BALLIET
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MISS
Other - First Name:JULIE
Other - Middle Name:KAY
Other - Last Name:HOLTZLANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:2425 ALPINE AVE NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49544-1956
Mailing Address - Country:US
Mailing Address - Phone:616-365-6033
Mailing Address - Fax:616-365-6065
Practice Address - Street 1:2425 ALPINE AVE NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49544-1956
Practice Address - Country:US
Practice Address - Phone:616-365-6033
Practice Address - Fax:616-365-6065
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302030735183500000X
IN26020696A183500000X
OH03-2-25038183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist