Provider Demographics
NPI:1164739892
Name:JOHNSON, CHARLOTTE LEE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CHARLOTTE
Middle Name:LEE
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 1:503 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-7989
Mailing Address - Country:US
Mailing Address - Phone:910-521-3910
Mailing Address - Fax:910-521-0705
Practice Address - Street 1:503 E 3RD ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28372-7989
Practice Address - Country:US
Practice Address - Phone:910-521-3910
Practice Address - Fax:910-521-0705
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21231183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist