Provider Demographics
NPI:1356626261
Name:JOHNSON, WILLIAM RAYMOND (RPH)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:RAYMOND
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 1:6417 N 400 W-90
Mailing Address - Street 2:
Mailing Address - City:MARKLE
Mailing Address - State:IN
Mailing Address - Zip Code:46770-9713
Mailing Address - Country:US
Mailing Address - Phone:260-758-9072
Mailing Address - Fax:
Practice Address - Street 1:1975 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:IN
Practice Address - Zip Code:46714-1182
Practice Address - Country:US
Practice Address - Phone:260-824-1643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26020270A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist