Provider Demographics
NPI:1588770382
Name:JANUSEK, MARY CATHERINE JOHNSON (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:MARY CATHERINE
Middle Name:JOHNSON
Last Name:JANUSEK
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:37 OLD DALLAS HWY SE
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-6869
Mailing Address - Country:US
Mailing Address - Phone:770-607-5897
Mailing Address - Fax:770-607-7365
Practice Address - Street 1:825 WEST AVE
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-6133
Practice Address - Country:US
Practice Address - Phone:770-607-5897
Practice Address - Fax:770-607-7365
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2017-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH022579183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist