Provider Demographics
NPI:1548860919
Name:HOSTETLER, JULIE
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:HOSTETLER
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 1:13663 SEBE DR
Mailing Address - Street 2:
Mailing Address - City:MARSHALLVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44645-9767
Mailing Address - Country:US
Mailing Address - Phone:330-988-0616
Mailing Address - Fax:
Practice Address - Street 1:3883 BURBANK RD
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-7220
Practice Address - Country:US
Practice Address - Phone:330-345-8820
Practice Address - Fax:330-345-2415
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-1-19192183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist