Provider Demographics
NPI:1992086094
Name:JULIAN, SETH SCOTT
Entity type:Individual
Prefix:MR
First Name:SETH
Middle Name:SCOTT
Last Name:JULIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:SETH
Other - Middle Name:SCOTT
Other - Last Name:JULIAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:10398 NE 240TH ST
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:OK
Mailing Address - Zip Code:73541-3002
Mailing Address - Country:US
Mailing Address - Phone:580-695-1265
Mailing Address - Fax:
Practice Address - Street 1:10398 NE 240TH ST
Practice Address - Street 2:
Practice Address - City:FLETCHER
Practice Address - State:OK
Practice Address - Zip Code:73541-3002
Practice Address - Country:US
Practice Address - Phone:580-695-1265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12628183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist