Provider Demographics
NPI:1073700787
Name:JOHNSON, VICTORIA ELIZABETH (CPHT)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ELIZABETH
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:VICKY
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CPHT
Mailing Address - Street 1:2502 N DODGE BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-2671
Mailing Address - Country:US
Mailing Address - Phone:520-901-6869
Mailing Address - Fax:520-618-6730
Practice Address - Street 1:2502 N DODGE BLVD.
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716
Practice Address - Country:US
Practice Address - Phone:520-901-6869
Practice Address - Fax:520-618-6730
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ250101030353299183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician