Provider Demographics
NPI:1295354710
Name:JOHNSON, LATOYA DENISE
Entity type:Individual
Prefix:
First Name:LATOYA
Middle Name:DENISE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24350 KUYKENDAHL RD
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-5119
Mailing Address - Country:US
Mailing Address - Phone:281-205-0533
Mailing Address - Fax:281-205-0839
Practice Address - Street 1:24350 KUYKENDAHL RD
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-5119
Practice Address - Country:US
Practice Address - Phone:281-205-0533
Practice Address - Fax:281-205-0839
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-14
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX44616183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty