Provider Demographics
NPI:1184187312
Name:JOHNSON, BEN BARTHOLOW (RPH)
Entity Type:Individual
Prefix:
First Name:BEN
Middle Name:BARTHOLOW
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:PO BOX 272
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52659-0272
Mailing Address - Country:US
Mailing Address - Phone:319-931-7698
Mailing Address - Fax:
Practice Address - Street 1:2485 HIGHWAY 92
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IA
Practice Address - Zip Code:52353-9337
Practice Address - Country:US
Practice Address - Phone:319-653-7218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-14
Last Update Date:2019-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA15877183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist