Provider Demographics
NPI:1801165535
Name:GILES, JULIE WALLACE (RPH)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:WALLACE
Last Name:GILES
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1756 HIGHWAY 48
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-9204
Mailing Address - Country:US
Mailing Address - Phone:931-552-2558
Mailing Address - Fax:931-552-7883
Practice Address - Street 1:1756 HIGHWAY 48
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-9204
Practice Address - Country:US
Practice Address - Phone:931-552-2558
Practice Address - Fax:931-552-7883
Is Sole Proprietor?:No
Enumeration Date:2011-12-27
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8887183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist