Provider Demographics
NPI:1194000497
Name:JOHNSON, RANDALL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:
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 1:800 SWIFT BLVD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3549
Mailing Address - Country:US
Mailing Address - Phone:509-713-7444
Mailing Address - Fax:
Practice Address - Street 1:800 SWIFT BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3549
Practice Address - Country:US
Practice Address - Phone:509-713-7444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-18
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00055912183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist