Provider Demographics
NPI:1265817324
Name:JOHNSON, KATELYN EILEEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:EILEEN
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 1:427 DELTA AVE
Mailing Address - Street 2:APT C2-32
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45226-1100
Mailing Address - Country:US
Mailing Address - Phone:513-519-5519
Mailing Address - Fax:
Practice Address - Street 1:4500 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:OH
Practice Address - Zip Code:45212-3118
Practice Address - Country:US
Practice Address - Phone:513-841-6620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03334550183500000X
KY017777183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist