Provider Demographics
NPI:1558186510
Name:JOHNSON, MARY ELLEN (PHARMD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELLEN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ELLEN
Other - Last Name:HARTSFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:10222 CREEK DALE LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-2368
Mailing Address - Country:US
Mailing Address - Phone:704-877-4198
Mailing Address - Fax:
Practice Address - Street 1:1550 FAULK ST STE 1500
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5088
Practice Address - Country:US
Practice Address - Phone:980-442-9616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16511183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist