Provider Demographics
NPI:1902052483
Name:JOHNSON, ANNIE (BS)
Entity Type:Individual
Prefix:MS
First Name:ANNIE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:BS
Other - Prefix:MS
Other - First Name:ANNIE
Other - Middle Name:
Other - Last Name:JOHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:14314 NORHILL POINTE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77044
Mailing Address - Country:US
Mailing Address - Phone:914-479-9966
Mailing Address - Fax:
Practice Address - Street 1:14314 NORHILL POINTE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77044-5358
Practice Address - Country:US
Practice Address - Phone:914-479-9966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-15
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045550183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist