Provider Demographics
NPI:1174086847
Name:JOHNSON, BLAKE RYAN (PHARMD)
Entity type:Individual
Prefix:
First Name:BLAKE
Middle Name:RYAN
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2723 NEW SALEM HWY
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128-5253
Mailing Address - Country:US
Mailing Address - Phone:615-396-6850
Mailing Address - Fax:615-396-6855
Practice Address - Street 1:2723 NEW SALEM HWY
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37128-5253
Practice Address - Country:US
Practice Address - Phone:615-396-6850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-10
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20432183500000X
GARPH032613183500000X
TN421411835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL20432OtherALABAMA BOARD OF PHARMACY LICENSE
TN42141OtherTENNESSEE BOARD OF PHARMACY LICENSE
GARPH032613OtherGEORGIA BOARD OF PHARMACY LICESNE