Provider Demographics
NPI:1427731280
Name:JOHNSON, WANDA M (CPHT)
Entity type:Individual
Prefix:MS
First Name:WANDA
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3303
Mailing Address - Street 2:TULANE AVENUE SUITE #3
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119
Mailing Address - Country:US
Mailing Address - Phone:504-302-1323
Mailing Address - Fax:504-324-4573
Practice Address - Street 1:7510 VANDERKLOOT AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70127-1648
Practice Address - Country:US
Practice Address - Phone:504-462-6143
Practice Address - Fax:504-324-4573
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA270101031154280183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician