Provider Demographics
NPI:1003017955
Name:JOHNSON, BARBARA ELLEN
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:ELLEN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8611 VANCE AVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32534-3312
Mailing Address - Country:US
Mailing Address - Phone:850-477-4757
Mailing Address - Fax:850-505-9543
Practice Address - Street 1:8611 VANCE AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32534-3312
Practice Address - Country:US
Practice Address - Phone:850-477-4757
Practice Address - Fax:850-505-9543
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician