Provider Demographics
NPI:1417351313
Name:JOHNSON, DAWN (PHARMD)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99721 CANYON VIEW DR
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99338-7562
Mailing Address - Country:US
Mailing Address - Phone:360-901-6556
Mailing Address - Fax:
Practice Address - Street 1:4820 N ROAD 68
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-9009
Practice Address - Country:US
Practice Address - Phone:509-543-7947
Practice Address - Fax:509-543-7949
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-21
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00055608183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist