Healthcare Provider Details

I. General information

NPI: 1669469391
Provider Name (Legal Business Name): JESSICA LYNN JOHNSON RPH, PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 06/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 LEBANON RD
MURFREESBORO TN
37129-1392
US

IV. Provider business mailing address

225 SPIRIT HILL CIR
SMYRNA TN
37167-8121
US

V. Phone/Fax

Practice location:
  • Phone: 615-439-0489
  • Fax:
Mailing address:
  • Phone: 615-355-8388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number24434
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: