Healthcare Provider Details

I. General information

NPI: 1982970505
Provider Name (Legal Business Name): LACHRISHA A. JOHNSON RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2012
Last Update Date: 03/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 MT.ZION RD.
MORROW GA
30260
US

IV. Provider business mailing address

1947 KEVIN DR.
CONYERS GA
30260
US

V. Phone/Fax

Practice location:
  • Phone: 678-201-0002
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number020340
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: