Provider Demographics
NPI:1689287062
Name:JOHSON, JANET LEIGH (RPH)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:LEIGH
Last Name:JOHSON
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 1:113 SCENIC OUTLET LN STE 1
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-9978
Mailing Address - Country:US
Mailing Address - Phone:336-352-5900
Mailing Address - Fax:336-352-5901
Practice Address - Street 1:113 SCENIC OUTLET LN STE 1
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-9978
Practice Address - Country:US
Practice Address - Phone:336-352-5900
Practice Address - Fax:336-352-5901
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC10955OtherPHARMACY PERMIT