Provider Demographics
NPI:1992936033
Name:JOHNSON, CHERYL LYNNE
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:LYNNE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:LYNNE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:19720 VENTURA BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-2609
Mailing Address - Country:US
Mailing Address - Phone:818-912-6800
Mailing Address - Fax:818-912-6989
Practice Address - Street 1:19720 VENTURA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2609
Practice Address - Country:US
Practice Address - Phone:818-912-6800
Practice Address - Fax:818-912-6989
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV09434183500000X
MI5302043909183500000X
VA0202214832183500000X
KY018189183500000X
CA40315183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist