Provider Demographics
NPI:1538143672
Name:JOHNSON, KELLI MICHELLE (CPHT)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:MICHELLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 UNION ST
Mailing Address - Street 2:#901
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1943
Mailing Address - Country:US
Mailing Address - Phone:206-437-1646
Mailing Address - Fax:
Practice Address - Street 1:2700 NE UNIVERSITY VLG
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-5008
Practice Address - Country:US
Practice Address - Phone:206-525-0705
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA00045187183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician