Provider Demographics
NPI:1356948269
Name:JOHNSON, BRANDI SUE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BRANDI
Middle Name:SUE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:BRANDI
Other - Middle Name:SUE
Other - Last Name:MCKEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:10105 LIMA RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46818-8657
Mailing Address - Country:US
Mailing Address - Phone:260-490-6522
Mailing Address - Fax:260-490-6524
Practice Address - Street 1:10105 LIMA RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46818-8657
Practice Address - Country:US
Practice Address - Phone:260-490-6522
Practice Address - Fax:260-490-6524
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-04
Last Update Date:2020-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26022482A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist