Provider Demographics
NPI:1275854135
Name:JOHNSON, PATRICK TREY (RPH)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:TREY
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 1:13776 N HWY 183
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-1872
Mailing Address - Country:US
Mailing Address - Phone:512-335-8821
Mailing Address - Fax:512-335-3946
Practice Address - Street 1:13776 N HWY 183
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1872
Practice Address - Country:US
Practice Address - Phone:512-335-8821
Practice Address - Fax:512-335-3946
Is Sole Proprietor?:No
Enumeration Date:2010-06-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31231183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist