Provider Demographics
NPI:1215123484
Name:JOHNSON, MARY MARGARET (PHARM D, MBA, MSCR)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:MARGARET
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHARM D, MBA, MSCR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 SUSAN DR
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-9211
Mailing Address - Country:US
Mailing Address - Phone:919-754-7048
Mailing Address - Fax:910-814-5303
Practice Address - Street 1:840 S BRIGHTLEAF BLVD
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4377
Practice Address - Country:US
Practice Address - Phone:919-934-7164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17745183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist