Provider Demographics
NPI:1366844458
Name:JOHNSON, TERRY LYNN II (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:LYNN
Last Name:JOHNSON
Suffix:II
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11100 PARKSIDE DRIVE
Mailing Address - Street 2:T-1370
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922
Mailing Address - Country:US
Mailing Address - Phone:865-675-8180
Mailing Address - Fax:
Practice Address - Street 1:11100 PARKSIDE DR
Practice Address - Street 2:T-1370
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-1960
Practice Address - Country:US
Practice Address - Phone:865-675-8180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-19
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN33072183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist