Healthcare Provider Details

I. General information

NPI: 1245360098
Provider Name (Legal Business Name): TAMI W. JOHNSON JR. PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HWY 421N
MCKEE KY
40447
US

IV. Provider business mailing address

8920 HIGHWAY 30 W
ANNVILLE KY
40402-9750
US

V. Phone/Fax

Practice location:
  • Phone: 606-287-7187
  • Fax: 606-287-3646
Mailing address:
  • Phone: 606-364-3423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10749
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: