MEDICARE: DR. MICHELLE ANN JOHNSON PHARMD, RPH

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	1164495	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1164495	OTHER	MN	BOARD OF PHARMACY

General Provider Information

NPI Number	:	1811992381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELLE ANN JOHNSON PHARMD, RPH

Provider Business Mailing Address
First Line	:	2833 LAPORT DR
Second Line	:
City	:	MOUNDS VIEW
State	:	MN
Zip	:	55112-5830
Country	:	US
Telephone Number	:	763-786-0664
Fax Number	:

Provider Business Practice Location Address
First Line	:	23122 SAINT FRANCIS BLVD NW
Second Line	:
City	:	ST FRANCIS
State	:	MN
Zip	:	55070-9807
Country	:	US
Telephone Number	:	763-753-0222
Fax Number	:	763-753-3994

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

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	07/08/2007

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