Provider Demographics
NPI:1467071753
Name:JOHNSON, SCOTT EARL (RPH)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:EARL
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 1:3918 LAWNWOODS DR
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50310-5328
Mailing Address - Country:US
Mailing Address - Phone:515-306-0542
Mailing Address - Fax:
Practice Address - Street 1:4815 MAPLE DR
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:IA
Practice Address - Zip Code:50327-2028
Practice Address - Country:US
Practice Address - Phone:515-265-6144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-16
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA17585183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist