Provider Demographics
NPI:1851947196
Name:JOHNSON, JULIE SCALLON (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:SCALLON
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 W BEL AIR AVE
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:MD
Mailing Address - Zip Code:21001-3221
Mailing Address - Country:US
Mailing Address - Phone:410-297-9400
Mailing Address - Fax:410-297-9415
Practice Address - Street 1:119 W BEL AIR AVE
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:MD
Practice Address - Zip Code:21001-3221
Practice Address - Country:US
Practice Address - Phone:410-297-9400
Practice Address - Fax:410-297-9415
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13623183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD407142500Medicaid