Individual
MARY JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
855 S RANDALL RD, ST CHARLES, IL 60174-1570
(616) 430-9555
Mailing address
855 S RANDALL RD, ST CHARLES, IL 60174-1570
Taxonomy
Speciality
Code
Description
License number
State
1835P1200X
Pharmacotherapy Pharmacist
Primary
051289349
IL
Other
Enumeration date
07/09/2014
Last updated
07/09/2014
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