Provider Demographics
NPI:1104944628
Name:JOHNSON, LISA K (PHARM D)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:K
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15412 CORBY ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-4190
Mailing Address - Country:US
Mailing Address - Phone:402-991-4321
Mailing Address - Fax:
Practice Address - Street 1:7710 MERCY RD
Practice Address - Street 2:MEDICAL BUILDING PHARMACY
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-2372
Practice Address - Country:US
Practice Address - Phone:402-398-6781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10957183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist