Provider Demographics
NPI:1295216588
Name:NIGG-JOHNSON, ELLEN MARIE (RPH)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:MARIE
Last Name:NIGG-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:PO BOX 67
Mailing Address - Street 2:
Mailing Address - City:BROWNS VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:56219-0067
Mailing Address - Country:US
Mailing Address - Phone:605-237-1349
Mailing Address - Fax:
Practice Address - Street 1:5473 WING AND FIN DRIVE
Practice Address - Street 2:
Practice Address - City:BROWNS VALLEY
Practice Address - State:MN
Practice Address - Zip Code:56219
Practice Address - Country:US
Practice Address - Phone:605-237-1349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN115995183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist