Provider Demographics
NPI:1396017174
Name:JOHNSON, DOUGLAS A (RPH)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:A
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 1:243 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4020
Mailing Address - Country:US
Mailing Address - Phone:503-648-1811
Mailing Address - Fax:503-640-1514
Practice Address - Street 1:243 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4020
Practice Address - Country:US
Practice Address - Phone:503-648-1811
Practice Address - Fax:503-640-1514
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0005854183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist