Provider Demographics
NPI:1730473554
Name:JOHNSON, CHERI
Entity Type:Individual
Prefix:
First Name:CHERI
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 US HIGHWAY 41 W
Mailing Address - Street 2:1334
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-9483
Mailing Address - Country:US
Mailing Address - Phone:906-226-0095
Mailing Address - Fax:906-226-0095
Practice Address - Street 1:3250 US HIGHWAY 41 W
Practice Address - Street 2:1334
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-9483
Practice Address - Country:US
Practice Address - Phone:906-226-0095
Practice Address - Fax:906-226-0095
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302027911183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist