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General NPI Number Information
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NPI Number | 1073288551
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Entity Type | Individual
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Provider Name | KASEY LYNN JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 08/16/2021
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Last Update Date | 06/18/2022
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Provider Practice Location Address
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Address Line | 130 DESIARD ST STE 300
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City | MONROE
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State | LA
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Zip | 71201-7363
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Country | US
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Telephone | 318-998-3907
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Fax |
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Provider Business Mailing Address
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Address Line | 836 LONEWA LN
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City | MONROE
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State | LA
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Zip | 71203-6524
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Country | US
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Telephone | 318-789-8806
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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 | PST.023974
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License Number State | LA
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