Provider Demographics
NPI:1487525283
Name:JOHNSON, JILL ELYSE
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:ELYSE
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 1:3151 KILBY RD
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-8309
Mailing Address - Country:US
Mailing Address - Phone:435-645-7945
Mailing Address - Fax:435-645-7945
Practice Address - Street 1:3151 KILBY RD
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-8309
Practice Address - Country:US
Practice Address - Phone:435-645-7945
Practice Address - Fax:435-645-7945
Is Sole Proprietor?:No
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7087970-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist