Provider Demographics
NPI:1114508926
Name:JOHNSON, CATHIE R (CPHT)
Entity Type:Individual
Prefix:
First Name:CATHIE
Middle Name:R
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3307 EVERGREEN WAY STE 4
Mailing Address - Street 2:
Mailing Address - City:WASHOUGAL
Mailing Address - State:WA
Mailing Address - Zip Code:98671-2063
Mailing Address - Country:US
Mailing Address - Phone:360-335-9255
Mailing Address - Fax:360-335-1355
Practice Address - Street 1:3307 EVERGREEN WAY STE 4
Practice Address - Street 2:
Practice Address - City:WASHOUGAL
Practice Address - State:WA
Practice Address - Zip Code:98671-2063
Practice Address - Country:US
Practice Address - Phone:360-335-9255
Practice Address - Fax:360-335-1355
Is Sole Proprietor?:No
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA60320172183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician