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1558186510 NPI number — MARY ELLEN JOHNSON PHARMD

NPI Number: 1558186510
Health Care Provider/Practitioner: MARY ELLEN JOHNSON PHARMD

Information about “1558186510” NPI (MARY ELLEN JOHNSON PHARMD) exists in 1558186510 in HTML format HTML  |  1558186510 in plain Text format TXT  |  1558186510 in PDF (Portable Document Format) PDF  |  1558186510 in an XML format XML  formats.

NPI Number : 1558186510 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1558186510",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "JOHNSON",
    "FirstName": "MARY",
    "MiddleName": "ELLEN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PHARMD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "HARTSFIELD",
    "OtherFirstName": "MARY",
    "OtherMiddleName": "ELLEN",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "PHARMD",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "10222 CREEK DALE LN",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CHARLOTTE",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "28277-2368",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "704-877-4198",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1550 FAULK ST STE 1500",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MONROE",
    "PracticeLocationAddressStateName": "NC",
    "PracticeLocationAddressPostalCode": "28112-5088",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "980-442-9616",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/15/2024",
    "LastUpdateDate": "11/15/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "183500000X",
        "TaxonomyName": "Pharmacist",
        "LicenseNumber": "16511",
        "LicenseNumberStateCode": "NC",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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