Individual
ELYSSA NICOLE JOHANNESEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
400 HIGHLAND AVE, LEWISTOWN, PA 17044-1167
(717) 242-7276
Mailing address
120 W SOUTH HILLS AVE, STATE COLLEGE, PA 16801-5929
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RP454685
PA
Other
Enumeration date
07/24/2020
Last updated
07/24/2020
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