Provider Demographics
NPI:1225394554
Name:JOHNSON, EDWARD MERLE II (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:MERLE
Last Name:JOHNSON
Suffix:II
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 1:424 PALISADES TRL
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-1508
Mailing Address - Country:US
Mailing Address - Phone:414-975-9370
Mailing Address - Fax:
Practice Address - Street 1:13485 VETERANS WAY STE 410
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-7762
Practice Address - Country:US
Practice Address - Phone:682-201-3911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-11
Last Update Date:2021-08-07
Deactivation Date:2018-05-31
Deactivation Code:
Reactivation Date:2018-06-14
Provider Licenses
StateLicense IDTaxonomies
ORRPH0016184183500000X
WVRP0006564183500000X
COPHA0021639183500000X
WI14019040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist