Provider Demographics
NPI:1285234773
Name:JOHNSON, LISA MARIA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARIA
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 1:5101 STONEWALL CT
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-2690
Mailing Address - Country:US
Mailing Address - Phone:757-615-5142
Mailing Address - Fax:
Practice Address - Street 1:1098 FREDERICK BLVD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-4119
Practice Address - Country:US
Practice Address - Phone:757-399-6150
Practice Address - Fax:757-399-6178
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17385183500000X
VA0202204178183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist