Provider Demographics
NPI:1851825038
Name:SIMPSON, JULIE
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:SIMPSON
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 1:109 ABNER JACKSON PKWY
Mailing Address - Street 2:STE. B
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-5159
Mailing Address - Country:US
Mailing Address - Phone:979-297-9503
Mailing Address - Fax:979-480-0254
Practice Address - Street 1:109 ABNER JACKSON PKWY
Practice Address - Street 2:STE. B
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5159
Practice Address - Country:US
Practice Address - Phone:979-297-9503
Practice Address - Fax:979-480-0254
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-14
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35567183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX199103601Medicare PIN