Active NPI
Katlyn Johnson
- Pharmacist
- Charleston, SC
National Provider Identifier
1003454620
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 42241
- Practice address
- 1200 Sam Rittenberg Blvd
Charleston, SC 29407-5006 - Phone
- (843) 573-4776
- NPI assigned
- Dec 13, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 42241 | SC | Primary |
Addresses
Primary practice location
1200 Sam Rittenberg Blvd
Charleston, SC 29407-5006
Mailing address
2056 Promenade CT
Mt Pleasant, SC 29466-7231
Phone (843) 860-1856
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 29466 | Medicaid | SC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 42241 | SC | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1576195200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1576195200000",
"number": "1003454620",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2056 PROMENADE CT",
"city": "MT PLEASANT",
"state": "SC",
"postal_code": "294667231",
"telephone_number": "843-860-1856"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1200 SAM RITTENBERG BLVD",
"city": "CHARLESTON",
"state": "SC",
"postal_code": "294075006",
"telephone_number": "843-573-4776"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "KATLYN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-12-13",
"last_updated": "2019-12-13",
"certification_date": "2019-12-13",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "SC",
"license": "42241",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "29466",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Charleston, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.