Provider Demographics
NPI:1912672734
Name:JOHNSON, LAUREN NICOLE (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:NICOLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4446 MOBILE DR APT 208
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-3730
Mailing Address - Country:US
Mailing Address - Phone:419-560-6575
Mailing Address - Fax:
Practice Address - Street 1:1033 N HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43201-2409
Practice Address - Country:US
Practice Address - Phone:614-340-6776
Practice Address - Fax:614-340-6774
Is Sole Proprietor?:No
Enumeration Date:2021-08-13
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03440908183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist