MEDICARE: KATIE K JOHNSON RPH, MA

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	11994	NV

General Provider Information

NPI Number	:	1548566292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE K JOHNSON RPH, MA

Provider Business Mailing Address
First Line	:	2393 CLEARVIEW DR
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89701-6515
Country	:	US
Telephone Number	:	775-885-0578
Fax Number	:	775-885-0578

Provider Business Practice Location Address
First Line	:	2393 CLEARVIEW DR
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89701-6515
Country	:	US
Telephone Number	:	775-885-0578
Fax Number	:	775-885-0578

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

Provider Enumeration Date	:	01/28/2011
Last Update Date	:	01/28/2011

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