Provider Demographics
NPI:1225310287
Name:JOHNSON, SUSAN NEYLANS (RPH)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:NEYLANS
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 RIVER OAK CIR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6743
Mailing Address - Country:US
Mailing Address - Phone:337-989-2782
Mailing Address - Fax:
Practice Address - Street 1:211 RIVER OAK CIR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6743
Practice Address - Country:US
Practice Address - Phone:337-989-2782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13514183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist