Active NPI
Renu Johnson
- Pharmacist
- Fort Wayne, IN
National Provider Identifier
1760140503
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 26028520A
- Practice address
- 5311 Coldwater Rd
Fort Wayne, IN 46825-5444 - Phone
- (260) 484-4528
- NPI assigned
- Nov 29, 2021
- 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 | 26028520A | IN | Primary |
Addresses
Primary practice location
5311 Coldwater Rd
Fort Wayne, IN 46825-5444
Mailing address
11008 Millwood CT
Fort Wayne, IN 46845-6153
Phone (520) 490-9347
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 |
|---|---|---|---|
| 26028520A | IN | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1638144000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1638144000000",
"number": "1760140503",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11008 MILLWOOD CT",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468456153",
"telephone_number": "520-490-9347"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5311 COLDWATER RD",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468255444",
"telephone_number": "260-484-4528"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "RENU",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-11-29",
"last_updated": "2021-11-29",
"certification_date": "2021-11-15",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IN",
"license": "26028520A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.