Provider Demographics
NPI:1225308182
Name:JOHNSON, DARA (CPHT, RPT)
Entity Type:Individual
Prefix:MRS
First Name:DARA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CPHT, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3135 STATE ROAD 580
Mailing Address - Street 2:SUITE 12
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-4976
Mailing Address - Country:US
Mailing Address - Phone:727-259-2000
Mailing Address - Fax:727-259-2001
Practice Address - Street 1:3135 STATE ROAD 580
Practice Address - Street 2:SUITE 12
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-4976
Practice Address - Country:US
Practice Address - Phone:727-259-2000
Practice Address - Fax:727-259-2001
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRPT29567183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician