Provider Demographics
NPI:1013670363
Name:JOHNSON, AMBER SHAY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AMBER
Middle Name:SHAY
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 1:1190 MADRID AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT GABRIEL
Mailing Address - State:LA
Mailing Address - Zip Code:70776-5332
Mailing Address - Country:US
Mailing Address - Phone:337-336-2411
Mailing Address - Fax:
Practice Address - Street 1:12502 HIGHWAY 431
Practice Address - Street 2:
Practice Address - City:SAINT AMANT
Practice Address - State:LA
Practice Address - Zip Code:70774-3418
Practice Address - Country:US
Practice Address - Phone:225-644-7288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-14
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.024027183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist