Individual
MELANIE M JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
621 EAGLEWOOD DR, REXBURG, ID 83440-5253
(208) 403-2364
Mailing address
621 EAGLEWOOD DR, REXBURG, ID 83440-5253
(208) 403-2364
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
4857624-1701
UT
183500000X
Pharmacist
P7155
ID
Other
Enumeration date
10/08/2016
Last updated
10/08/2016
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