Provider Demographics
NPI:1881004232
Name:JOHANNES, CATHRINE ANN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:CATHRINE
Middle Name:ANN
Last Name:JOHANNES
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 1:8191 S STATE RD
Mailing Address - Street 2:
Mailing Address - City:GOODRICH
Mailing Address - State:MI
Mailing Address - Zip Code:48438-9723
Mailing Address - Country:US
Mailing Address - Phone:810-636-2979
Mailing Address - Fax:
Practice Address - Street 1:8191 S STATE RD
Practice Address - Street 2:
Practice Address - City:GOODRICH
Practice Address - State:MI
Practice Address - Zip Code:48438-9723
Practice Address - Country:US
Practice Address - Phone:810-636-2979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-06
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI530202585183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist