Provider Demographics
NPI:1114194735
Name:JOHNSON, ROBERT DANIEL (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:DANIEL
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 1:10401 OLD GEORGETOWN RD #205
Mailing Address - Street 2:PATIENT PHARMACY
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814
Mailing Address - Country:US
Mailing Address - Phone:301-571-0860
Mailing Address - Fax:301-571-0850
Practice Address - Street 1:903 E FORT AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-4762
Practice Address - Country:US
Practice Address - Phone:410-962-5546
Practice Address - Fax:410-962-0577
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09458183500000X
GA019841183500000X
MI532023473183500000X
MN113415183500000X
MI5302023473183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD09458OtherPHARMACIST
MN113415OtherPHARMACIST
MI5302023473OtherPHARMACIST
GA019841OtherPHARMACIST