Provider Demographics
NPI:1437456928
Name:JOHNSON, CHANDA MICHELLE (DOCTOR OF PHARMACY)
Entity Type:Individual
Prefix:DR
First Name:CHANDA
Middle Name:MICHELLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DOCTOR OF PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2115 PLEASANTON RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78221-1300
Mailing Address - Country:US
Mailing Address - Phone:210-923-7717
Mailing Address - Fax:210-923-3720
Practice Address - Street 1:2115 PLEASANTON RD STE 100
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78221-1300
Practice Address - Country:US
Practice Address - Phone:210-923-7717
Practice Address - Fax:210-923-3720
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-17
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS015699183500000X
TX513561835N0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835N0905XPharmacy Service ProvidersPharmacistNuclear
No183500000XPharmacy Service ProvidersPharmacist