MEDICARE: TARA JOHNSON PHARMD

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
1	183500000X	Pharmacist	03331425	OH

General Provider Information

NPI Number	:	1508469164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA JOHNSON PHARMD

Provider Business Mailing Address
First Line	:	2857 MARKBREIT AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45209-2019
Country	:	US
Telephone Number	:	513-313-5631
Fax Number	:

Provider Business Practice Location Address
First Line	:	7700 HAMILTON AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45231-3104
Country	:	US
Telephone Number	:	513-729-1630
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2020
Last Update Date	:	11/17/2020

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