Provider Demographics
NPI:1255995726
Name:JOHNSON, JENNIFER HELEN (RPH)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:HELEN
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 1:1414 W FAIR AVE STE 133
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-5408
Mailing Address - Country:US
Mailing Address - Phone:906-225-3902
Mailing Address - Fax:906-226-2661
Practice Address - Street 1:1414 W FAIR AVE
Practice Address - Street 2:STE 133
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-5408
Practice Address - Country:US
Practice Address - Phone:906-225-3902
Practice Address - Fax:906-226-2661
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMI5302029979183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist