| NPI | 1679203004 |
|---|---|
| Former Name | VIVIAN GRACE JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KY 012214) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03224561) |
| Enumeration Date | 2022-06-17 |
| Last Update Date | 2022-06-17 |