Provider Demographics
NPI:1033513486
Name:RIDEWOOD, JULIE
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:RIDEWOOD
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 1:3711 88TH ST NE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-7214
Mailing Address - Country:US
Mailing Address - Phone:360-530-7761
Mailing Address - Fax:360-530-7795
Practice Address - Street 1:3711 88TH ST NE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-7214
Practice Address - Country:US
Practice Address - Phone:360-530-7761
Practice Address - Fax:360-530-7795
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-14
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00017126183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPH00017126OtherSTATE PHARMACIST LICENSE