Provider Demographics
NPI:1184731200
Name:JOHNSON, CATHY JEAN (RPH)
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:JEAN
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 1:4623 WESLEY AVE
Mailing Address - Street 2:SUITE H
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-2272
Mailing Address - Country:US
Mailing Address - Phone:513-396-6060
Mailing Address - Fax:
Practice Address - Street 1:4623 WESLEY AVE
Practice Address - Street 2:SUITE H
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45212-2272
Practice Address - Country:US
Practice Address - Phone:513-396-6060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03114790183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist