Healthcare Provider Details

I. General information

NPI: 1962310474
Provider Name (Legal Business Name): SKYLER JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 W CEDAR AVE
GLADWIN MI
48624-2065
US

IV. Provider business mailing address

507 SHORT ST
GLADWIN MI
48624-1459
US

V. Phone/Fax

Practice location:
  • Phone: 989-709-5288
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number5303047059
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: