Provider Demographics
NPI:1023013687
Name:JOHNSON, SUSAN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 INWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-2803
Mailing Address - Country:US
Mailing Address - Phone:256-461-4474
Mailing Address - Fax:
Practice Address - Street 1:3054 LEEMAN FERRY RD SW
Practice Address - Street 2:SUITE J-1
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-6509
Practice Address - Country:US
Practice Address - Phone:256-881-5130
Practice Address - Fax:256-885-2338
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9527183500000X
TN6737183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist