Provider Demographics
NPI:1275220758
Name:JOHNSON, MARY KREPS (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KREPS
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 1:704 COUNTY ROAD 282
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35057-4951
Mailing Address - Country:US
Mailing Address - Phone:205-613-8252
Mailing Address - Fax:
Practice Address - Street 1:WALMART PHARMACY
Practice Address - Street 2:5601 AL HWY 157
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35058
Practice Address - Country:US
Practice Address - Phone:256-615-6666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15088183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist