Provider Demographics
NPI:1093131989
Name:JOHNSON, DENISE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DENISE
Middle Name:
Last Name:JOHNSON
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 1:10509 HEARTLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:CAMBY
Mailing Address - State:IN
Mailing Address - Zip Code:46113-9123
Mailing Address - Country:US
Mailing Address - Phone:317-821-6810
Mailing Address - Fax:317-821-6865
Practice Address - Street 1:10509 HEARTLAND BLVD
Practice Address - Street 2:
Practice Address - City:CAMBY
Practice Address - State:IN
Practice Address - Zip Code:46113-9123
Practice Address - Country:US
Practice Address - Phone:317-821-6810
Practice Address - Fax:317-821-6865
Is Sole Proprietor?:No
Enumeration Date:2014-03-15
Last Update Date:2024-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26021168A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist