Provider Demographics
NPI:1447597141
Name:JOHNSON, PHILIP M (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:M
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 1:4047 ASPEN CHASE DR
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-9039
Mailing Address - Country:US
Mailing Address - Phone:239-207-1090
Mailing Address - Fax:
Practice Address - Street 1:14543 GLOBAL PKWY
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33913-9446
Practice Address - Country:US
Practice Address - Phone:833-886-1725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-15
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS46598183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist