Provider Demographics
NPI:1417568551
Name:JOHNS, HARRY MILES III (PHARMD)
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:MILES
Last Name:JOHNS
Suffix:III
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 1:3410 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40211-2824
Mailing Address - Country:US
Mailing Address - Phone:502-776-2528
Mailing Address - Fax:502-776-8044
Practice Address - Street 1:3410 W BROADWAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40211-2824
Practice Address - Country:US
Practice Address - Phone:502-776-2528
Practice Address - Fax:502-776-8044
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY016610183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist