MEDICARE: CATHY JEAN JOHNSON R.PH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	03114790	OH

General Provider Information

NPI Number	:	1184731200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHY JEAN JOHNSON R.PH.

Provider Business Mailing Address
First Line	:	4623 WESLEY AVE
Second Line	:	SUITE H
City	:	CINCINNATI
State	:	OH
Zip	:	45212-2272
Country	:	US
Telephone Number	:	513-396-6060
Fax Number	:

Provider Business Practice Location Address
First Line	:	4623 WESLEY AVE
Second Line	:	SUITE H
City	:	CINCINNATI
State	:	OH
Zip	:	45212-2272
Country	:	US
Telephone Number	:	513-396-6060
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	07/08/2007

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