Provider Demographics
NPI:1740880574
Name:JOHNS, VICKIE (RPH)
Entity type:Individual
Prefix:
First Name:VICKIE
Middle Name:
Last Name:JOHNS
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 1:3245 LAWRENCEVILLE SUWANEE RD
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6541
Mailing Address - Country:US
Mailing Address - Phone:678-482-1646
Mailing Address - Fax:678-482-1289
Practice Address - Street 1:3245 LAWRENCEVILLE SUWANEE RD
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6541
Practice Address - Country:US
Practice Address - Phone:678-482-1646
Practice Address - Fax:678-482-1289
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA017838183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist