Provider Demographics
NPI:1467850974
Name:JOHNSON, MICHAEL ERIC (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ERIC
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 SW STONEGATE TER
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32024-3452
Mailing Address - Country:US
Mailing Address - Phone:386-754-5377
Mailing Address - Fax:386-487-0309
Practice Address - Street 1:161 SW STONEGATE TER
Practice Address - Street 2:SUITE 105
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32024-3452
Practice Address - Country:US
Practice Address - Phone:386-754-5377
Practice Address - Fax:386-487-0309
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-15
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS46612183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist