Provider Demographics
NPI:1043727589
Name:JOHNSON, KAYLEIGH M (PHARMD)
Entity Type:Individual
Prefix:
First Name:KAYLEIGH
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2804 LAKEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43231-4860
Mailing Address - Country:US
Mailing Address - Phone:614-639-9006
Mailing Address - Fax:
Practice Address - Street 1:2000 TAMARACK RD FL 2
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1183
Practice Address - Country:US
Practice Address - Phone:220-564-2670
Practice Address - Fax:220-564-2674
Is Sole Proprietor?:No
Enumeration Date:2018-01-05
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26024849A183500000X
OH03132418183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist