Provider Demographics
NPI:1902260730
Name:BORLAUG, JULIE
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:BORLAUG
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 1:531 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:MT HOLLY
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-1032
Mailing Address - Country:US
Mailing Address - Phone:609-704-1784
Mailing Address - Fax:609-702-1253
Practice Address - Street 1:531 HIGH ST
Practice Address - Street 2:
Practice Address - City:MT HOLLY
Practice Address - State:NJ
Practice Address - Zip Code:08060-1032
Practice Address - Country:US
Practice Address - Phone:609-702-1784
Practice Address - Fax:609-702-1253
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-07
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRI02920800183500000X
MT3757183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist