Provider Demographics
NPI:1457635567
Name:JOHNSON, DAVID HOWARD (RPH)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:HOWARD
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 1:13251 BRIDGEFORD AVE
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-3451
Mailing Address - Country:US
Mailing Address - Phone:239-992-2899
Mailing Address - Fax:239-992-2899
Practice Address - Street 1:706 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-3722
Practice Address - Country:US
Practice Address - Phone:517-265-6675
Practice Address - Fax:517-263-8207
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS38361183500000X
MI5302021075183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist