Healthcare Provider Details

I. General information

NPI: 1275589400
Provider Name (Legal Business Name): SHELLA RANAE JOHNSON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 03/07/2024
Certification Date: 03/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 HIGHWAY 6 W
IOWA CITY IA
52246-2292
US

IV. Provider business mailing address

750 PERRY CT
IOWA CITY IA
52245-5242
US

V. Phone/Fax

Practice location:
  • Phone: 319-338-0581
  • Fax:
Mailing address:
  • Phone: 319-339-7494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number19649
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: