Provider Demographics
NPI:1366841512
Name:JOHNSON, JONI KETT (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JONI
Middle Name:KETT
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 1:6715 SHALLOWFORD RD
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27023-9724
Mailing Address - Country:US
Mailing Address - Phone:336-946-0220
Mailing Address - Fax:336-946-0199
Practice Address - Street 1:6715 SHALLOWFORD RD
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27023-9724
Practice Address - Country:US
Practice Address - Phone:336-946-0220
Practice Address - Fax:336-946-0199
Is Sole Proprietor?:No
Enumeration Date:2014-08-13
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13505183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist