Healthcare Provider Details

I. General information

NPI: 1407750136
Provider Name (Legal Business Name): EMILY GRACE JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1806 WATER ST
LECOMPTE LA
71346-9545
US

IV. Provider business mailing address

PO BOX 369
LECOMPTE LA
71346-0369
US

V. Phone/Fax

Practice location:
  • Phone: 318-776-5649
  • Fax: 318-776-9212
Mailing address:
  • Phone: 318-776-5649
  • Fax: 318-776-9212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number016773
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: