Provider Demographics
NPI:1417258799
Name:PERSON, PATRICIA JOHNSON (RPH)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:JOHNSON
Last Name:PERSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 HEATHERWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:LOUISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:27549-7375
Mailing Address - Country:US
Mailing Address - Phone:919-496-1617
Mailing Address - Fax:919-340-1101
Practice Address - Street 1:15 HEATHERWOOD TRL
Practice Address - Street 2:
Practice Address - City:LOUISBURG
Practice Address - State:NC
Practice Address - Zip Code:27549-7375
Practice Address - Country:US
Practice Address - Phone:919-496-1617
Practice Address - Fax:919-340-1101
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC09590183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist