Provider Demographics
NPI:1598365116
Name:JOHNSON, CAROL ANN (RPH)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:386 VZ COUNTY ROAD 1214
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:TX
Mailing Address - Zip Code:75103-6562
Mailing Address - Country:US
Mailing Address - Phone:903-829-5002
Mailing Address - Fax:
Practice Address - Street 1:603 E STATE HIGHWAY 243
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:TX
Practice Address - Zip Code:75103-2420
Practice Address - Country:US
Practice Address - Phone:903-567-6578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-01
Last Update Date:2020-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36338183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist