Provider Demographics
NPI:1760082689
Name:JOHNSON, JENNIFER VOKE
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:VOKE
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 1:100 HIGHLANDS MALL
Mailing Address - Street 2:
Mailing Address - City:NATRONA HEIGHTS
Mailing Address - State:PA
Mailing Address - Zip Code:15065-1971
Mailing Address - Country:US
Mailing Address - Phone:724-226-6960
Mailing Address - Fax:724-226-6962
Practice Address - Street 1:100 HIGHLANDS MALL
Practice Address - Street 2:
Practice Address - City:NATRONA HEIGHTS
Practice Address - State:PA
Practice Address - Zip Code:15065-1971
Practice Address - Country:US
Practice Address - Phone:724-226-6960
Practice Address - Fax:724-226-6962
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP040110L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist