Provider Demographics
NPI:1295021376
Name:JOHNSON, SHERRY LYNN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:LYNN
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 1:6169 W STONER DR
Mailing Address - Street 2:STE 180
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-7322
Mailing Address - Country:US
Mailing Address - Phone:317-866-1060
Mailing Address - Fax:317-866-1068
Practice Address - Street 1:6169 W STONER DR
Practice Address - Street 2:STE 180
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-7322
Practice Address - Country:US
Practice Address - Phone:317-866-1060
Practice Address - Fax:317-866-1068
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26019231A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist