Provider Demographics
NPI:1487084497
Name:WAHMANN, JULIE (RPH)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:WAHMANN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2909 COURT ST
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554-6203
Mailing Address - Country:US
Mailing Address - Phone:309-347-5904
Mailing Address - Fax:
Practice Address - Street 1:2909 COURT ST
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-6203
Practice Address - Country:US
Practice Address - Phone:309-347-5904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051039585183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist