Provider Demographics
NPI:1962923128
Name:JOHNSON, RICHARD EDWARD (RPH)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:EDWARD
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 1:1305 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-6622
Mailing Address - Country:US
Mailing Address - Phone:954-755-4921
Mailing Address - Fax:954-346-1715
Practice Address - Street 1:1305 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-6622
Practice Address - Country:US
Practice Address - Phone:954-755-4921
Practice Address - Fax:954-346-1715
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0028912183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist