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General NPI Number Information
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NPI Number | 1467712026
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Entity Type | Individual
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Provider Name | ELISE MICHELLA JOHNSON PHARM D.
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Gender | Female
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Dates
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Enumeration Date | 05/16/2012
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Last Update Date | 04/17/2017
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Provider Practice Location Address
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Address Line | 3615 19TH ST FL 1
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City | LUBBOCK
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State | TX
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Zip | 79410-1203
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Country | US
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Telephone | 806-725-7979
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Fax |
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Provider Business Mailing Address
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Address Line | 5007 92ND ST
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City | LUBBOCK
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State | TX
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Zip | 79424-4803
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Country | US
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Telephone | 806-544-9456
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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 | 50009
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License Number State | TX
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