Provider Demographics
NPI:1457652794
Name:JOHNSON, BRENDA L (RPH)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:L
Last Name:JOHNSON
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 1:989 SUNRISE AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4506
Mailing Address - Country:US
Mailing Address - Phone:916-773-4115
Mailing Address - Fax:916-773-4173
Practice Address - Street 1:989 SUNRISE AVE
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4506
Practice Address - Country:US
Practice Address - Phone:916-773-4115
Practice Address - Fax:916-773-4173
Is Sole Proprietor?:No
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54243183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist