Provider Demographics
NPI:1083903991
Name:JOHNSON, BETH M (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BETH
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:PO BOX 63
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:MI
Mailing Address - Zip Code:48847-0063
Mailing Address - Country:US
Mailing Address - Phone:989-875-3380
Mailing Address - Fax:989-875-2424
Practice Address - Street 1:1010 EAST CENTER STREET
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:MI
Practice Address - Zip Code:48847
Practice Address - Country:US
Practice Address - Phone:989-875-3380
Practice Address - Fax:989-875-2424
Is Sole Proprietor?:No
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302032979183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist