Healthcare Provider Details

I. General information

NPI: 1215682422
Provider Name (Legal Business Name): LAURA JOHNSON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2022
Last Update Date: 02/16/2022
Certification Date: 02/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E WOODROW WILSON AVE # A40
JACKSON MS
39216-5116
US

IV. Provider business mailing address

1500 E WOODROW WILSON AVE # A40
JACKSON MS
39216-5116
US

V. Phone/Fax

Practice location:
  • Phone: 601-364-1556
  • Fax:
Mailing address:
  • Phone: 601-364-1556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE-13988
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: