Provider Demographics
NPI:1316486707
Name:JOHNSON, KIMBERLEY (RPH)
Entity type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12910 TOTEM LAKE BLVD NE STE 101
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-2901
Mailing Address - Country:US
Mailing Address - Phone:425-814-5003
Mailing Address - Fax:425-814-5020
Practice Address - Street 1:12910 TOTEM LAKE BLVD NE STE 101
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-2901
Practice Address - Country:US
Practice Address - Phone:425-814-5003
Practice Address - Fax:425-814-5020
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-17
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00013657183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist