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NPI Code Detail

MEDICARE: BONNIE JOHNSON P.D.

MEDICARE: BONNIE JOHNSON P.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist6861AR

General Provider Information

NPI Number : 1194712612
Entity Type Code : Individual
Provider Name (Legal Business Name) : BONNIE JOHNSON P.D.
Provider Business Mailing Address
First Line : 1002 S 26TH ST
Second Line :
City : FORT SMITH
State : AR
Zip : 72901-4118
Country : US
Telephone Number : 479-782-5940
Fax Number : 479-783-0433
Provider Business Practice Location Address
First Line : 3610 GRAND AVE
Second Line :
City : FORT SMITH
State : AR
Zip : 72904-6842
Country : US
Telephone Number : 479-783-5171
Fax Number : 479-783-0433
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/29/2005
Last Update Date : 07/08/2007

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Directions to “ BONNIE JOHNSON P.D.” Practice Location

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