Provider Demographics
NPI:1033373246
Name:JOHNSON, MICHELLE JACKSON (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:JACKSON
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 1:1820 HUNTERS FOREST DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6631
Mailing Address - Country:US
Mailing Address - Phone:336-774-1216
Mailing Address - Fax:336-765-1437
Practice Address - Street 1:1820 HUNTERS FOREST DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-6631
Practice Address - Country:US
Practice Address - Phone:336-774-1216
Practice Address - Fax:336-765-1437
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10714183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist