Provider Demographics
NPI:1083724223
Name:JOHNSON, PAMELA BYRNE (RPH, CPH,)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:BYRNE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RPH, CPH,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4021 AUDUBON DR
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-3309
Mailing Address - Country:US
Mailing Address - Phone:727-536-7685
Mailing Address - Fax:
Practice Address - Street 1:2200 TALL PINES DR
Practice Address - Street 2:SUITE 118
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-5341
Practice Address - Country:US
Practice Address - Phone:727-524-9333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPU626183500000X
FLPS13520183500000X
AL7378183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist