Provider Demographics
NPI:1124156484
Name:JOHNSON, KARL FREDERICK II (RPH)
Entity type:Individual
Prefix:MR
First Name:KARL
Middle Name:FREDERICK
Last Name:JOHNSON
Suffix:II
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4326 WEATHERBY LN
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-9628
Mailing Address - Country:US
Mailing Address - Phone:231-933-9360
Mailing Address - Fax:
Practice Address - Street 1:13916 SOUTH WEST BAYSHORE DR.
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684
Practice Address - Country:US
Practice Address - Phone:231-946-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302410930183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist