Provider Demographics
NPI:1699043919
Name:JOHNSON, KATHLEEN K (PHARMD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:K
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:PO BOX 10008
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87184-0008
Mailing Address - Country:US
Mailing Address - Phone:505-553-5822
Mailing Address - Fax:
Practice Address - Street 1:428 BALLTOWN RD
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12304-2245
Practice Address - Country:US
Practice Address - Phone:518-346-8670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-01
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057733183500000X
NMRP00007915183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist