Provider Demographics
NPI:1033199252
Name:JOHNSON, BEN R (RPH)
Entity Type:Individual
Prefix:
First Name:BEN
Middle Name:R
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 1:311 E MONTICELLO DR
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-2813
Mailing Address - Country:US
Mailing Address - Phone:801-544-2686
Mailing Address - Fax:801-544-2686
Practice Address - Street 1:3795 KIESEL AVE
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-1601
Practice Address - Country:US
Practice Address - Phone:801-394-6414
Practice Address - Fax:801-394-6113
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT148205-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist