Provider Demographics
NPI:1548637556
Name:LARCH, JULIE
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:LARCH
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 1:450 SALEM DR APT U
Mailing Address - Street 2:
Mailing Address - City:VERMILION
Mailing Address - State:OH
Mailing Address - Zip Code:44089-3273
Mailing Address - Country:US
Mailing Address - Phone:440-960-3835
Mailing Address - Fax:
Practice Address - Street 1:450 SALEM DR APT U
Practice Address - Street 2:
Practice Address - City:VERMILION
Practice Address - State:OH
Practice Address - Zip Code:44089-3273
Practice Address - Country:US
Practice Address - Phone:440-960-3835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-25
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03335077-3183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist