Provider Demographics
NPI:1467712026
Name:JOHNSON, ELISE MICHELLA (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:ELISE
Middle Name:MICHELLA
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 1:5007 92ND ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-4803
Mailing Address - Country:US
Mailing Address - Phone:806-544-9456
Mailing Address - Fax:
Practice Address - Street 1:3615 19TH ST FL 1
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1203
Practice Address - Country:US
Practice Address - Phone:806-725-7979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-16
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50009183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist