Provider Demographics
NPI:1235670340
Name:JOHANEK, MIKE (PHARMD)
Entity Type:Individual
Prefix:
First Name:MIKE
Middle Name:
Last Name:JOHANEK
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 1:8333 ROCKSIDE ROAD
Mailing Address - Street 2:
Mailing Address - City:VALLEY VIEW
Mailing Address - State:OH
Mailing Address - Zip Code:44125
Mailing Address - Country:US
Mailing Address - Phone:216-369-2200
Mailing Address - Fax:216-369-2201
Practice Address - Street 1:8333 ROCKSIDE ROAD
Practice Address - Street 2:
Practice Address - City:VALLEY VIEW
Practice Address - State:OH
Practice Address - Zip Code:44125
Practice Address - Country:US
Practice Address - Phone:216-369-2200
Practice Address - Fax:216-369-2201
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03334543-3183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist