Provider Demographics
NPI:1427656693
Name:MASTERS, JULIE MARIE (PHARMD)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:MARIE
Last Name:MASTERS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1778 N 703RD LN
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:IL
Mailing Address - Zip Code:62347-4701
Mailing Address - Country:US
Mailing Address - Phone:217-779-3394
Mailing Address - Fax:
Practice Address - Street 1:1400 HARRISON ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-6706
Practice Address - Country:US
Practice Address - Phone:217-222-2930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-11
Last Update Date:2020-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005013330183500000X
IL051.290274183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist