MEDICARE: AMY CAROLINE 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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	61032	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	61032	OTHER	TX	TX STATE BOARD OF PHARMACY LICENSE

General Provider Information

NPI Number	:	1710582754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY CAROLINE JOHNSON PHARMD

Provider Business Mailing Address
First Line	:	515 HOUSTON ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76102-3933
Country	:	US
Telephone Number	:	817-820-0488
Fax Number	:	817-776-4102

Provider Business Practice Location Address
First Line	:	515 HOUSTON ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76102-3933
Country	:	US
Telephone Number	:	817-820-0488
Fax Number	:	817-776-4102

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

Provider Enumeration Date	:	11/30/2020
Last Update Date	:	11/30/2020

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