Provider Demographics
NPI:1588905863
Name:CHILDRESS, JULIUS ROMALO
Entity type:Individual
Prefix:MR
First Name:JULIUS
Middle Name:ROMALO
Last Name:CHILDRESS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7706 SUMMERDALE DR
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77469-4631
Mailing Address - Country:US
Mailing Address - Phone:281-239-5801
Mailing Address - Fax:
Practice Address - Street 1:1616 N ALABAMA RD
Practice Address - Street 2:
Practice Address - City:WHARTON
Practice Address - State:TX
Practice Address - Zip Code:77488-3204
Practice Address - Country:US
Practice Address - Phone:979-282-2883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-11
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41906183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist