Basic Information
| Provider Information | |||||||||
| NPI: | 1003017955 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | BARBARA | ||||||||
| MiddleName: | ELLEN | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 8611 VANCE AVE | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325343312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504774757 | ||||||||
| FaxNumber: | 8505059543 | ||||||||
| Practice Location | |||||||||
| Address1: | 8611 VANCE AVE | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325343312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504774757 | ||||||||
| FaxNumber: | 8505059543 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183700000X | Y | Pharmacy Service Providers | Pharmacy Technician |
No ID Information.