Provider Demographics
NPI:1730501974
Name:JOHNSON, MARTHA ERIN (PHARM D)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:ERIN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5341 HIGHWAY 25
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-6173
Mailing Address - Country:US
Mailing Address - Phone:601-992-8144
Mailing Address - Fax:
Practice Address - Street 1:5341 HIGHWAY 25
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-6173
Practice Address - Country:US
Practice Address - Phone:601-992-8144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-07
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS010366183500000X
SC13236183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist