Provider Demographics
NPI:1023511896
Name:JOHNSON, HUGH BRIAN (DPH)
Entity type:Individual
Prefix:
First Name:HUGH
Middle Name:BRIAN
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 JENNIFER LN
Mailing Address - Street 2:
Mailing Address - City:SELMER
Mailing Address - State:TN
Mailing Address - Zip Code:38375-6702
Mailing Address - Country:US
Mailing Address - Phone:731-645-3207
Mailing Address - Fax:731-645-8943
Practice Address - Street 1:1017 MULBERRY AVE
Practice Address - Street 2:
Practice Address - City:SELMER
Practice Address - State:TN
Practice Address - Zip Code:38375-3274
Practice Address - Country:US
Practice Address - Phone:731-645-3207
Practice Address - Fax:731-645-8943
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11343183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist