Provider Demographics
NPI:1992788178
Name:JOHNSON, JARED KEITH (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:JARED
Middle Name:KEITH
Last Name:JOHNSON
Suffix:
Gender:M
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 1:2428 E UNIVERSITY DR
Mailing Address - Street 2:#501
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-7601
Mailing Address - Country:US
Mailing Address - Phone:334-501-1288
Mailing Address - Fax:
Practice Address - Street 1:765 E GLENN AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-5151
Practice Address - Country:US
Practice Address - Phone:334-821-6538
Practice Address - Fax:334-821-7087
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14160183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist