Provider Demographics
NPI:1366425712
Name:KING, JULIE ANNA (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANNA
Last Name:KING
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANNA
Other - Last Name:TENNENHOUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:5 CAMINO DE LA QUESTA DEL AIRE
Mailing Address - Street 2:
Mailing Address - City:PLACITAS
Mailing Address - State:NM
Mailing Address - Zip Code:87043-8837
Mailing Address - Country:US
Mailing Address - Phone:505-867-2739
Mailing Address - Fax:505-867-6527
Practice Address - Street 1:SAN FELIPE HEALTH CLINIC PHARMACY
Practice Address - Street 2:CEDAR STREET #4 SAN FELIPE PUEBLO
Practice Address - City:SAN FELIPE
Practice Address - State:NM
Practice Address - Zip Code:87001
Practice Address - Country:US
Practice Address - Phone:505-867-2739
Practice Address - Fax:505-867-6527
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00005733183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMRP00005733OtherPHARMACIST LICENSE
NMBF030171OtherNISPC DIABETES MANAGEMENT