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General NPI Number Information
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NPI Number | 1295542280
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Entity Type | Individual
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Provider Name | JENILEE JOHNSON PHARMD
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Gender | Female
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Dates
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Enumeration Date | 12/13/2024
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 98 POPLAR ST
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City | BLACKFOOT
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State | ID
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Zip | 83221-1758
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Country | US
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Telephone | 208-785-3866
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Fax |
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Provider Business Mailing Address
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Address Line | 5785 S 5TH AVE APT D
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City | POCATELLO
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State | ID
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Zip | 83204-2348
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Country | US
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Telephone | 208-251-3422
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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 | P6554
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License Number State | ID
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