Provider Demographics
NPI:1962773416
Name:JOHNSON, KAREN J (RPH)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:J
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10112 S 150 W
Mailing Address - Street 2:
Mailing Address - City:BUNKER HILL
Mailing Address - State:IN
Mailing Address - Zip Code:46914-9520
Mailing Address - Country:US
Mailing Address - Phone:765-689-8634
Mailing Address - Fax:
Practice Address - Street 1:5510 HOWARD ST
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-2620
Practice Address - Country:US
Practice Address - Phone:847-588-7170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-14
Last Update Date:2012-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26017462A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist