Provider Demographics
NPI:1801499736
Name:JOHNSON, ANNA ELISABETH (PHARMD)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:ELISABETH
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 1:311 S CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:LAKE VIEW
Mailing Address - State:SC
Mailing Address - Zip Code:29563-3422
Mailing Address - Country:US
Mailing Address - Phone:843-601-4691
Mailing Address - Fax:
Practice Address - Street 1:85 MATHEWS DR
Practice Address - Street 2:
Practice Address - City:HILTON HEAD
Practice Address - State:SC
Practice Address - Zip Code:29926-3609
Practice Address - Country:US
Practice Address - Phone:843-681-8363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-21
Last Update Date:2020-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC42677183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist