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General NPI Number Information
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NPI Number | 1285839589
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Entity Type | Individual
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Provider Name | SUSAN JANE JOHNSON RPH
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Gender | Female
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Dates
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Enumeration Date | 06/18/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1501 S DIRKSEN PKWY
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City | SPRINGFIELD
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State | IL
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Zip | 62703-2128
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Country | US
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Telephone | 217-527-8408
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Fax |
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Provider Business Mailing Address
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Address Line | 189 N MEADOWBROOK RD
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City | SPRINGFIELD
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State | IL
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Zip | 62711-9223
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Country | US
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Telephone | 217-793-0485
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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 |
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License Number State | IL
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