Provider Demographics
NPI:1043502842
Name:JOHN, JOJI (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOJI
Middle Name:
Last Name:JOHN
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 1:230 KELSO DR
Mailing Address - Street 2:
Mailing Address - City:KELSO
Mailing Address - State:WA
Mailing Address - Zip Code:98626-3112
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:230 KELSO DR
Practice Address - Street 2:RITE AID
Practice Address - City:KELSO
Practice Address - State:WA
Practice Address - Zip Code:98626-3112
Practice Address - Country:US
Practice Address - Phone:360-577-2693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-11
Last Update Date:2011-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60152157183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist