Provider Demographics
NPI:1346504537
Name:JOHNSON, ERIC (PHARM D)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PHARM D
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 263
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:AR
Mailing Address - Zip Code:71862-0263
Mailing Address - Country:US
Mailing Address - Phone:870-703-9715
Mailing Address - Fax:
Practice Address - Street 1:1004 W COMMERCE
Practice Address - Street 2:
Practice Address - City:HOPE
Practice Address - State:AR
Practice Address - Zip Code:71801-2528
Practice Address - Country:US
Practice Address - Phone:870-777-4830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-02
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD11997183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist