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General NPI Number Information
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NPI Number | 1861785529
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Entity Type | Individual
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Provider Name | SUZETTE B. JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 05/26/2011
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Last Update Date | 05/26/2011
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Provider Practice Location Address
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Address Line | 3301 STEPHANIE ST
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City | HOUMA
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State | LA
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Zip | 70363-3731
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Country | US
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Telephone | 985-851-5288
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Fax |
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Provider Business Mailing Address
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Address Line | 1214 GRAND CAILLOU RD
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City | HOUMA
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State | LA
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Zip | 70363-5555
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Country | US
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Telephone | 985-872-3171
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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 | 14899
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License Number State | LA
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