Provider Demographics
NPI:1417394693
Name:JOHNSON, SHANNON YOW (PHARM D)
Entity Type:Individual
Prefix:MR
First Name:SHANNON
Middle Name:YOW
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 CLUB HOUSE DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-2471
Mailing Address - Country:US
Mailing Address - Phone:404-735-0953
Mailing Address - Fax:
Practice Address - Street 1:140 WOODSTOCK SQUARE AVE
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-6500
Practice Address - Country:US
Practice Address - Phone:678-494-5307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH019614183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist