Healthcare Provider Details

I. General information

NPI: 1629388152
Provider Name (Legal Business Name): CASSANDRA B JOHNSON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2010
Last Update Date: 11/17/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 AZALEA DR
WAYNESBORO MS
39367-2257
US

IV. Provider business mailing address

11 MAYFIELD RD
LAUREL MS
39443-8460
US

V. Phone/Fax

Practice location:
  • Phone: 601-735-3194
  • Fax: 601-735-5202
Mailing address:
  • Phone: 205-269-5940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14707
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: