Cassandra B Johnson, PHARMD
Individual provider Active NPI Pharmacist · Waynesboro, MS
NPI 1629388152 · NPPES record last updated Nov 17, 2023
Key facts
- NPI
- 1629388152
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 14707 (AL)
- Practice address
- 1350 Azalea Dr
Waynesboro, MS 39367-2257 - Phone
- (601) 735-3194
- Fax
- (601) 735-5202
- NPI assigned
- Oct 18, 2010
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14707 | AL | MD | Anesthesiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Freds Stores of Tennessee Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 14707 | AL | Yes |
Addresses
Primary practice location
1350 Azalea Dr
Waynesboro, MS 39367-2257
Mailing address
11 Mayfield Rd
Laurel, MS 39443-8460
Phone (205) 269-5940
Other providers in Waynesboro, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 17, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.