Provider Demographics
NPI:1538760160
Name:BEDSOLE, JULIE ANN (RPH)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:ANN
Last Name:BEDSOLE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:MONTGOMERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:701 AW DR
Mailing Address - Street 2:
Mailing Address - City:STONEWALL
Mailing Address - State:LA
Mailing Address - Zip Code:71078-9669
Mailing Address - Country:US
Mailing Address - Phone:318-469-0170
Mailing Address - Fax:
Practice Address - Street 1:7400 YOUREE DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5536
Practice Address - Country:US
Practice Address - Phone:318-798-0566
Practice Address - Fax:318-798-1467
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.016060183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist