Healthcare Provider Details

I. General information

NPI: 1962337485
Provider Name (Legal Business Name): JENNIFER JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7845 WISE AVE
BALTIMORE MD
21222-3339
US

IV. Provider business mailing address

424 HOWIL TER
BALTIMORE MD
21212-3008
US

V. Phone/Fax

Practice location:
  • Phone: 410-285-1401
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberT28463
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: