Provider Demographics
NPI:1144637422
Name:COON, JULIA (R PH)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:COON
Suffix:
Gender:F
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7101 W 37TH ST N
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-9360
Mailing Address - Country:US
Mailing Address - Phone:316-721-5036
Mailing Address - Fax:316-721-1705
Practice Address - Street 1:7101 W 37TH ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-9360
Practice Address - Country:US
Practice Address - Phone:316-721-5036
Practice Address - Fax:316-721-1705
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-13982183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist