Provider Demographics
NPI:1881291698
Name:JOHANNS, JENNY NATASHA (PHARMD)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:NATASHA
Last Name:JOHANNS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 RANDOLPH AVE
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-3948
Mailing Address - Country:US
Mailing Address - Phone:304-636-5696
Mailing Address - Fax:
Practice Address - Street 1:505 RANDOLPH AVE
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-3948
Practice Address - Country:US
Practice Address - Phone:304-636-5696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV0007014183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist