MEDICARE: DR. JESSICA CHARNELLE JOHNSON PHARMD, RPH

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	20668	AL

General Provider Information

NPI Number	:	1760095913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSICA CHARNELLE JOHNSON PHARMD, RPH

Provider Business Mailing Address
First Line	:	101 GREENVILLE BYP
Second Line	:
City	:	GREENVILLE
State	:	AL
Zip	:	36037-3724
Country	:	US
Telephone Number	:	334-382-1414
Fax Number	:	334-382-1432

Provider Business Practice Location Address
First Line	:	101 GREENVILLE BYP
Second Line	:
City	:	GREENVILLE
State	:	AL
Zip	:	36037-3724
Country	:	US
Telephone Number	:	334-382-1414
Fax Number	:	334-382-1432

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

Provider Enumeration Date	:	08/27/2020
Last Update Date	:	08/27/2020

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