Provider Demographics
NPI:1942594809
Name:JOHNSON-ELLENBERGER, KAREN E (RPH)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:E
Last Name:JOHNSON-ELLENBERGER
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 1:3410 DR M L KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-5220
Mailing Address - Country:US
Mailing Address - Phone:252-638-3021
Mailing Address - Fax:252-638-3021
Practice Address - Street 1:3410 DR M L KING JR BLVD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-5220
Practice Address - Country:US
Practice Address - Phone:252-638-3021
Practice Address - Fax:252-638-3021
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC008112183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist