Provider Demographics
NPI:1316389596
Name:JOHNSON, JENNIFER MACKE (PHARMD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MACKE
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 1:9002 N MERIDIAN ST
Mailing Address - Street 2:SUITE 213
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-5381
Mailing Address - Country:US
Mailing Address - Phone:317-587-7400
Mailing Address - Fax:317-587-7410
Practice Address - Street 1:9002 N MERIDIAN ST
Practice Address - Street 2:SUITE 213
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-5381
Practice Address - Country:US
Practice Address - Phone:317-587-7400
Practice Address - Fax:317-587-7410
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-29
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26024547A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist