Provider Demographics
NPI:1699060772
Name:JOHNSON, ROSS A (RPH)
Entity type:Individual
Prefix:MR
First Name:ROSS
Middle Name:A
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 1:42625 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92203-9737
Mailing Address - Country:US
Mailing Address - Phone:760-863-3601
Mailing Address - Fax:760-863-3650
Practice Address - Street 1:42625 JACKSON ST
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92203-9737
Practice Address - Country:US
Practice Address - Phone:760-863-3601
Practice Address - Fax:760-863-3650
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56602183500000X
NY043715183500000X
NV15281183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist