Provider Demographics
NPI:1194908111
Name:JOHNSON, DAVID LYNN (RPH)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:LYNN
Last Name:JOHNSON
Suffix:
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 1:4 172ND PL SW
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-9113
Mailing Address - Country:US
Mailing Address - Phone:425-745-2598
Mailing Address - Fax:
Practice Address - Street 1:21540 30TH DR SE STE 400
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-7015
Practice Address - Country:US
Practice Address - Phone:425-424-7140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-13
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00016291183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist