Healthcare Provider Details

I. General information

NPI: 1609153147
Provider Name (Legal Business Name): DR. MONIQUEA JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2011
Last Update Date: 04/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9085 HIGHWAY 64
ARLINGTON TN
38002-7981
US

IV. Provider business mailing address

PO BOX 2122
CORDOVA TN
38088-2122
US

V. Phone/Fax

Practice location:
  • Phone: 901-382-1533
  • Fax:
Mailing address:
  • Phone: 901-290-5412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0000010307
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: