Provider Demographics
NPI:1225771314
Name:JOHNSON, JOHN LIAM (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:LIAM
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 1:2710 S WILLOW WAY
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-2737
Mailing Address - Country:US
Mailing Address - Phone:740-357-8116
Mailing Address - Fax:
Practice Address - Street 1:101 JAMES RD
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:OH
Practice Address - Zip Code:45690-1017
Practice Address - Country:US
Practice Address - Phone:740-947-5018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-16
Last Update Date:2022-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0326500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist