Provider Demographics
NPI:1073712188
Name:JERNIGAN, MICHELLE JOHNSON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:JOHNSON
Last Name:JERNIGAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:MICHELLE
Other - Middle Name:LEIGH
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1900 PINE STREET
Mailing Address - Street 2:ROOM 2801
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601
Mailing Address - Country:US
Mailing Address - Phone:325-676-7948
Mailing Address - Fax:
Practice Address - Street 1:1900 PINE STREET
Practice Address - Street 2:ROOM 2801
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601
Practice Address - Country:US
Practice Address - Phone:325-670-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH023679183500000X
TX45248183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist