Active NPI
Kelley Johnson, PHARMD
- Pharmacist
- Philadelphia, PA
National Provider Identifier
1871105403
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RP450005
- Practice address
- 2014 S Broad St
Philadelphia, PA 19145-2305 - Phone
- (215) 551-3818
- NPI assigned
- Aug 17, 2020
- 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 | RP450005 | PA | Primary |
Addresses
Primary practice location
2014 S Broad St
Philadelphia, PA 19145-2305
Mailing address
2332 S Hemberger St
Philadelphia, PA 19145-3315
Phone (931) 801-3234
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
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RP450005 | PA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1597622400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1597622400000",
"number": "1871105403",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2332 S HEMBERGER ST",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191453315",
"telephone_number": "931-801-3234"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2014 S BROAD ST",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191452305",
"telephone_number": "215-551-3818"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "KELLEY",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-08-17",
"last_updated": "2020-08-17",
"certification_date": "2020-08-17",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "PA",
"license": "RP450005",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.