Provider Demographics
NPI:1528588084
Name:JOHNSON, LEAH (PHARMD)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
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 1:241 COUNTRY ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:AL
Mailing Address - Zip Code:35570-4820
Mailing Address - Country:US
Mailing Address - Phone:205-921-2889
Mailing Address - Fax:205-921-2834
Practice Address - Street 1:1706 MILITARY ST S
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:AL
Practice Address - Zip Code:35570-5021
Practice Address - Country:US
Practice Address - Phone:205-921-2889
Practice Address - Fax:205-921-2834
Is Sole Proprietor?:No
Enumeration Date:2017-06-26
Last Update Date:2017-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16195183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL16195OtherALABAMA STATE BOARD OF PHARMACY