Provider Demographics
NPI:1801468574
Name:JOHNSON, KAREN TRENICE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:TRENICE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:KAREN
Other - Middle Name:TRENICE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:6 RICHBURG RD APT 1
Mailing Address - Street 2:
Mailing Address - City:PURVIS
Mailing Address - State:MS
Mailing Address - Zip Code:39475-3467
Mailing Address - Country:US
Mailing Address - Phone:601-249-6725
Mailing Address - Fax:
Practice Address - Street 1:5093 HARDY ST
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1336
Practice Address - Country:US
Practice Address - Phone:601-579-6698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-100264183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist