Provider Demographics
NPI:1487857363
Name:JOHNSON, PATRICIA ELIZABETH (PHARMACIST)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ELIZABETH
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:PATRICK
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:PO BOX 696
Mailing Address - Street 2:
Mailing Address - City:INEZ
Mailing Address - State:KY
Mailing Address - Zip Code:41224-0696
Mailing Address - Country:US
Mailing Address - Phone:606-298-4215
Mailing Address - Fax:
Practice Address - Street 1:200 ROCKCASTLE ROAD
Practice Address - Street 2:
Practice Address - City:INEZ
Practice Address - State:KY
Practice Address - Zip Code:41224-0696
Practice Address - Country:US
Practice Address - Phone:606-298-4215
Practice Address - Fax:606-298-3101
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY010457183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist