Provider Demographics
NPI:1487243010
Name:JOHNSON, MELISSA M
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 N VAN LINGLE MUNGO BLVD
Mailing Address - Street 2:
Mailing Address - City:PAGELAND
Mailing Address - State:SC
Mailing Address - Zip Code:29728-2317
Mailing Address - Country:US
Mailing Address - Phone:843-672-2420
Mailing Address - Fax:
Practice Address - Street 1:205 N VAN LINGLE MUNGO BLVD
Practice Address - Street 2:
Practice Address - City:PAGELAND
Practice Address - State:SC
Practice Address - Zip Code:29728-2317
Practice Address - Country:US
Practice Address - Phone:843-672-2420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician