Provider Demographics
NPI:1275636672
Name:JOHNSON, MERRILEE S (RPH)
Entity Type:Individual
Prefix:
First Name:MERRILEE
Middle Name:S
Last Name:JOHNSON
Suffix:
Gender:F
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:PO BOX 14900
Mailing Address - Street 2:OREGON STATE HOSPITAL LIRS UNIT
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97309-5016
Mailing Address - Country:US
Mailing Address - Phone:503-945-2800
Mailing Address - Fax:
Practice Address - Street 1:2600 CENTER ST NE
Practice Address - Street 2:OREGON STATE HOSPITAL
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2669
Practice Address - Country:US
Practice Address - Phone:503-945-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6126183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist