Individual
CHAD LANE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARM.D.
Contact information
Practice address
1500 E WOODROW WILSON AVE, JACKSON, MS 39216-5199
(601) 364-1555
Mailing address
1500 E WOODROW WILSON AVE, JACKSON, MS 39216-5116
(601) 364-1555
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
E-09359
MS
Other
Enumeration date
04/04/2012
Last updated
04/04/2012
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