Provider Demographics
NPI:1093063323
Name:JOHNSON, CHARLES ALEXANDER (PHARMD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:ALEXANDER
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 CRAIG DR APT 118
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-4510
Mailing Address - Country:US
Mailing Address - Phone:865-208-1060
Mailing Address - Fax:
Practice Address - Street 1:3030 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-4317
Practice Address - Country:US
Practice Address - Phone:214-387-8743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX52068183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist