Provider Demographics
NPI:1417730953
Name:JOHNSON, CHLOE TRACE (PHARMD)
Entity Type:Individual
Prefix:
First Name:CHLOE
Middle Name:TRACE
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 1:5648 FIELDCREST AVE
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38134-3424
Mailing Address - Country:US
Mailing Address - Phone:614-313-2925
Mailing Address - Fax:
Practice Address - Street 1:3775 HACKS CROSS RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-2302
Practice Address - Country:US
Practice Address - Phone:901-214-0053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN47332183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist