Provider Demographics
NPI:1811992381
Name:JOHNSON, MICHELLE ANN (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:DR
Other - First Name:MICHELLE
Other - Middle Name:ANN
Other - Last Name:GROSSMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD, RPH
Mailing Address - Street 1:2833 LAPORT DR
Mailing Address - Street 2:
Mailing Address - City:MOUNDS VIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55112-5830
Mailing Address - Country:US
Mailing Address - Phone:763-786-0664
Mailing Address - Fax:
Practice Address - Street 1:23122 SAINT FRANCIS BLVD NW
Practice Address - Street 2:
Practice Address - City:ST FRANCIS
Practice Address - State:MN
Practice Address - Zip Code:55070-9807
Practice Address - Country:US
Practice Address - Phone:763-753-0222
Practice Address - Fax:763-753-3994
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1164495183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1164495OtherBOARD OF PHARMACY