Provider Demographics
NPI:1104429844
Name:JOHNSON, ANDREA LYNN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:LYNN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 HANCOCK BRIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:NORTH FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33903-4251
Mailing Address - Country:US
Mailing Address - Phone:239-997-3733
Mailing Address - Fax:
Practice Address - Street 1:4100 HANCOCK BRIDGE PKWY
Practice Address - Street 2:
Practice Address - City:NORTH FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33903-4251
Practice Address - Country:US
Practice Address - Phone:239-997-3733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS594971835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric