Provider Demographics
NPI:1720545783
Name:JOHNSON, CAROLINE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CAROLINE
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 1:1006 N HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74801-6419
Mailing Address - Country:US
Mailing Address - Phone:405-273-7360
Mailing Address - Fax:405-273-4384
Practice Address - Street 1:1006 N HARRISON AVE
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74801-6419
Practice Address - Country:US
Practice Address - Phone:405-273-7360
Practice Address - Fax:405-273-4384
Is Sole Proprietor?:No
Enumeration Date:2019-02-26
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14334183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist