Provider Demographics
NPI:1558947861
Name:JOHNSON, CHERYL DENISE (RPH)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:DENISE
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 1:2731 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-1220
Mailing Address - Country:US
Mailing Address - Phone:215-805-3881
Mailing Address - Fax:
Practice Address - Street 1:5800 RIDGE AVENUE
Practice Address - Street 2:PHARMACY-BASEMENT
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128
Practice Address - Country:US
Practice Address - Phone:215-487-4323
Practice Address - Fax:215-487-4352
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA034727L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist