Provider Demographics
NPI:1396704490
Name:SHIVER, JULIE BROCK (PHARMACIST)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:BROCK
Last Name:SHIVER
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 AVENUE B
Mailing Address - Street 2:
Mailing Address - City:APALACHICOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32320-1952
Mailing Address - Country:US
Mailing Address - Phone:850-653-8074
Mailing Address - Fax:
Practice Address - Street 1:115 AVENUE B
Practice Address - Street 2:
Practice Address - City:APALACHICOLA
Practice Address - State:FL
Practice Address - Zip Code:32320-1952
Practice Address - Country:US
Practice Address - Phone:850-653-8074
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS23028183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist