MEDICARE: JENNIFER JOHNSON PHARMD

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	RPH027519	GA

General Provider Information

NPI Number	:	1932706686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER JOHNSON PHARMD

Provider Business Mailing Address
First Line	:	461 S COLUMBIA AVE
Second Line	:
City	:	RINCON
State	:	GA
Zip	:	31326-9446
Country	:	US
Telephone Number	:	912-826-7665
Fax Number	:	912-826-7667

Provider Business Practice Location Address
First Line	:	461 S COLUMBIA AVE
Second Line	:
City	:	RINCON
State	:	GA
Zip	:	31326-9446
Country	:	US
Telephone Number	:	912-826-7665
Fax Number	:	912-826-7667

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

Provider Enumeration Date	:	10/06/2020
Last Update Date	:	10/06/2020

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