Provider Demographics
NPI:1013373612
Name:JOHNSON, ANGELA L (PHARMD, MBA, MS)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHARMD, MBA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 JEFFERSON ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-2643
Mailing Address - Country:US
Mailing Address - Phone:202-744-6896
Mailing Address - Fax:
Practice Address - Street 1:620 JEFFERSON ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-2643
Practice Address - Country:US
Practice Address - Phone:202-744-6896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-12
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202214553183500000X
DCPH10001882183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist