Provider Demographics
NPI:1003545062
Name:JOHNSON, AFSSATOU NADIA (PHARM D)
Entity Type:Individual
Prefix:
First Name:AFSSATOU NADIA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3847 TIMBERGLEN RD APT 4424
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-3840
Mailing Address - Country:US
Mailing Address - Phone:240-314-9157
Mailing Address - Fax:
Practice Address - Street 1:1104 S WESTMORELAND RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75211-5651
Practice Address - Country:US
Practice Address - Phone:214-467-3540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70077183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist