Provider Demographics
NPI:1174259923
Name:JOHNSON, TAYLOR W (PHARMD)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:W
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 1:7341 TAZEWELL PIKE
Mailing Address - Street 2:
Mailing Address - City:CORRYTON
Mailing Address - State:TN
Mailing Address - Zip Code:37721-3516
Mailing Address - Country:US
Mailing Address - Phone:865-219-6092
Mailing Address - Fax:
Practice Address - Street 1:7341 TAZEWELL PIKE
Practice Address - Street 2:
Practice Address - City:CORRYTON
Practice Address - State:TN
Practice Address - Zip Code:37721-3516
Practice Address - Country:US
Practice Address - Phone:865-219-6092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN46174183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist