Provider Demographics
NPI:1013421346
Name:JOHNSON, NANCY ANN (RPH)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:ANN
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 1:7207 S RIVERBEND RD
Mailing Address - Street 2:
Mailing Address - City:BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:49402-9370
Mailing Address - Country:US
Mailing Address - Phone:231-288-0368
Mailing Address - Fax:
Practice Address - Street 1:961 SPRING ST
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-3278
Practice Address - Country:US
Practice Address - Phone:231-722-2861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-22
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020228801835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist