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General NPI Number Information
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NPI Number | 1003454620
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Entity Type | Individual
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Provider Name | KATLYN JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 12/13/2019
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Last Update Date | 12/13/2019
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Provider Practice Location Address
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Address Line | 1200 SAM RITTENBERG BLVD
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City | CHARLESTON
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State | SC
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Zip | 29407-5006
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Country | US
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Telephone | 843-573-4776
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Fax |
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Provider Business Mailing Address
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Address Line | 2056 PROMENADE CT
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City | MT PLEASANT
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State | SC
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Zip | 29466-7231
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Country | US
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Telephone | 843-860-1856
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 42241
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License Number State | SC
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