Provider Demographics
NPI:1518230135
Name:JOHNSON, JANETTE MARIE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JANETTE
Middle Name:MARIE
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 1:4750 SW WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-3431
Mailing Address - Country:US
Mailing Address - Phone:503-626-4710
Mailing Address - Fax:503-626-0590
Practice Address - Street 1:4750 SW WESTERN AVE
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-3431
Practice Address - Country:US
Practice Address - Phone:503-626-4710
Practice Address - Fax:503-626-0590
Is Sole Proprietor?:No
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0007502183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORRPH-0007502OtherSTATE PHARMACIST LICENSE