Provider Demographics
NPI:1730784950
Name:JOHNSON, SALLY ROSE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SALLY
Middle Name:ROSE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2219 MOUNT PLEASANT CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:FINCASTLE
Mailing Address - State:VA
Mailing Address - Zip Code:24090-3572
Mailing Address - Country:US
Mailing Address - Phone:540-958-2865
Mailing Address - Fax:
Practice Address - Street 1:1610 MAIN ST
Practice Address - Street 2:
Practice Address - City:CLIFTON FORGE
Practice Address - State:VA
Practice Address - Zip Code:24422-1904
Practice Address - Country:US
Practice Address - Phone:540-862-4223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202218002183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist