Provider Demographics
NPI:1588949838
Name:JOHNSON, RHONDA FLORENCE (REGISTERED PHARMACIS)
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:FLORENCE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:REGISTERED PHARMACIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7364 DEEP RUN
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48301-3805
Mailing Address - Country:US
Mailing Address - Phone:248-731-7390
Mailing Address - Fax:248-731-7390
Practice Address - Street 1:1921 E 8 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48091-2402
Practice Address - Country:US
Practice Address - Phone:586-755-3046
Practice Address - Fax:586-755-4348
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302028627183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist