Provider Demographics
NPI:1942432943
Name:JOHNSON, KATHERINE L (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 OTAGO WAY
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29170-3098
Mailing Address - Country:US
Mailing Address - Phone:803-463-5323
Mailing Address - Fax:
Practice Address - Street 1:2209 W DEKALB ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020-2158
Practice Address - Country:US
Practice Address - Phone:803-425-9527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-10
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11215183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist