Provider Demographics
NPI:1538143672
Name:JOHNSON, KELLI MICHELLE (CPHT)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:MICHELLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 SE 106TH AVE
Mailing Address - Street 2:SUITE 103, PMB 228
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684
Mailing Address - Country:US
Mailing Address - Phone:206-920-8958
Mailing Address - Fax:
Practice Address - Street 1:720 SE 106TH AVE
Practice Address - Street 2:SUITE 103, PMB 228
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684
Practice Address - Country:US
Practice Address - Phone:206-920-8958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2025-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA00045187183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician