Provider Demographics
NPI:1275960288
Name:JOHNSON, ELIZABETH STIMPSON (RPH)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:STIMPSON
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:STIMPSON
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:PO BOX 1343
Mailing Address - Street 2:
Mailing Address - City:CAROLINA BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28428-1343
Mailing Address - Country:US
Mailing Address - Phone:910-458-1204
Mailing Address - Fax:
Practice Address - Street 1:1224 N NORWOOD ST
Practice Address - Street 2:
Practice Address - City:WALLACE
Practice Address - State:NC
Practice Address - Zip Code:28466-1334
Practice Address - Country:US
Practice Address - Phone:910-285-5787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-04
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC06264183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist