Provider Demographics
NPI:1467799254
Name:JOHANSON, ELIZABETH A (PHARMD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:JOHANSON
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 1:7431 N FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-1601
Mailing Address - Country:US
Mailing Address - Phone:561-997-6265
Mailing Address - Fax:561-997-2812
Practice Address - Street 1:7431 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-1601
Practice Address - Country:US
Practice Address - Phone:561-997-6265
Practice Address - Fax:561-997-2812
Is Sole Proprietor?:No
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS36991183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist