Provider Demographics
NPI:1235733205
Name:JOHNSON, WILLIAM ERIC ANDREW (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ERIC ANDREW
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 1:60 VIEW TERRACE DR STE 11
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:KY
Mailing Address - Zip Code:41071-5404
Mailing Address - Country:US
Mailing Address - Phone:859-638-2830
Mailing Address - Fax:
Practice Address - Street 1:1100 HANSEL AVE
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-4869
Practice Address - Country:US
Practice Address - Phone:859-371-2245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY021594183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist