Basic Information
| Provider Information | |||||||||
| NPI: | 1194712612 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | BONNIE | ||||||||
| MiddleName: | |||||||||
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| Credential: | P.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1002 S 26TH ST | ||||||||
| Address2: | |||||||||
| City: | FORT SMITH | ||||||||
| State: | AR | ||||||||
| PostalCode: | 729014118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4797825940 | ||||||||
| FaxNumber: | 4797830433 | ||||||||
| Practice Location | |||||||||
| Address1: | 3610 GRAND AVE | ||||||||
| Address2: | |||||||||
| City: | FORT SMITH | ||||||||
| State: | AR | ||||||||
| PostalCode: | 729046842 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4797835171 | ||||||||
| FaxNumber: | 4797830433 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 6861 | AR | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.