Provider Demographics
NPI:1740995984
Name:JOHNSON, MEREDITH ANN ADELLE (PHARMD, BCPS)
Entity type:Individual
Prefix:DR
First Name:MEREDITH
Middle Name:ANN ADELLE
Last Name:JOHNSON
Suffix:
Gender:
Credentials:PHARMD, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 WOODSIDE CIR
Mailing Address - Street 2:
Mailing Address - City:DRESDEN
Mailing Address - State:TN
Mailing Address - Zip Code:38225-2370
Mailing Address - Country:US
Mailing Address - Phone:731-217-4472
Mailing Address - Fax:
Practice Address - Street 1:1620 CENTURY CENTER PKWY
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38134-8849
Practice Address - Country:US
Practice Address - Phone:800-235-8498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-23
Last Update Date:2025-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY022926183500000X
TN46262183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist