Provider Demographics
NPI:1154423812
Name:JOHNSON, DANA N
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:N
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9333 ANGEL VIEW LN
Mailing Address - Street 2:
Mailing Address - City:KIMBERLY
Mailing Address - State:AL
Mailing Address - Zip Code:35091-3136
Mailing Address - Country:US
Mailing Address - Phone:205-590-0673
Mailing Address - Fax:
Practice Address - Street 1:4701 CENTER POINT RD
Practice Address - Street 2:
Practice Address - City:PINSON
Practice Address - State:AL
Practice Address - Zip Code:35126-4209
Practice Address - Country:US
Practice Address - Phone:205-680-3969
Practice Address - Fax:205-680-0935
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14854183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist