Provider Demographics
NPI:1942212220
Name:JOHNSON, SUSAN K (MS PHARMACY)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:K
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 MISSOURI AVE
Mailing Address - Street 2:MCXP-CCS-CR
Mailing Address - City:FORT LEONARD WOOD
Mailing Address - State:MO
Mailing Address - Zip Code:65473-8952
Mailing Address - Country:US
Mailing Address - Phone:573-596-0417
Mailing Address - Fax:573-596-0524
Practice Address - Street 1:126 MISSOURI AVE
Practice Address - Street 2:MCXP-CCS-CR
Practice Address - City:FORT LEONARD WOOD
Practice Address - State:MO
Practice Address - Zip Code:65473-8952
Practice Address - Country:US
Practice Address - Phone:573-596-0417
Practice Address - Fax:573-596-0524
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO28815183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist