Provider Demographics
NPI:1245360098
Name:JOHNSON, TAMI W JR (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TAMI
Middle Name:W
Last Name:JOHNSON
Suffix:JR
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 1:8920 HIGHWAY 30 W
Mailing Address - Street 2:
Mailing Address - City:ANNVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40402-9750
Mailing Address - Country:US
Mailing Address - Phone:606-364-3423
Mailing Address - Fax:
Practice Address - Street 1:HWY 421N
Practice Address - Street 2:
Practice Address - City:MCKEE
Practice Address - State:KY
Practice Address - Zip Code:40447
Practice Address - Country:US
Practice Address - Phone:606-287-7187
Practice Address - Fax:606-287-3646
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10749183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist