Provider Demographics
NPI:1932551868
Name:JOHNSON, COURTNEY NICOLE (PHARM D)
Entity type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:NICOLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:859 FRANKLIN SPRINGS ST
Mailing Address - Street 2:
Mailing Address - City:ROYSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30662-3931
Mailing Address - Country:US
Mailing Address - Phone:706-245-8595
Mailing Address - Fax:706-245-1128
Practice Address - Street 1:859 FRANKLIN SPRINGS ST
Practice Address - Street 2:
Practice Address - City:ROYSTON
Practice Address - State:GA
Practice Address - Zip Code:30662-3931
Practice Address - Country:US
Practice Address - Phone:706-245-8595
Practice Address - Fax:706-245-1128
Is Sole Proprietor?:No
Enumeration Date:2016-07-02
Last Update Date:2016-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH029182183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist