Provider Demographics
NPI:1083995567
Name:JOHNSON, ELISABETH B (PHARMD)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:B
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 1:5 PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-1928
Mailing Address - Country:US
Mailing Address - Phone:413-773-3801
Mailing Address - Fax:413-773-9371
Practice Address - Street 1:5 PIERCE ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-1928
Practice Address - Country:US
Practice Address - Phone:413-773-3801
Practice Address - Fax:413-773-9371
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA25984183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist