Provider Demographics
NPI:1427616051
Name:JOHNSON, KENYA FREDERICK (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KENYA
Middle Name:FREDERICK
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 1:11691 CHERRY BARK DR E
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-7676
Mailing Address - Country:US
Mailing Address - Phone:904-240-5465
Mailing Address - Fax:
Practice Address - Street 1:4250 PHILIPS HWY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-6730
Practice Address - Country:US
Practice Address - Phone:904-737-7001
Practice Address - Fax:904-737-7310
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS51156183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist