Provider Demographics
NPI:1568764405
Name:JOHNSON, CARL THOMAS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:THOMAS
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 1:13201 RITTENHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-6245
Mailing Address - Country:US
Mailing Address - Phone:804-763-5406
Mailing Address - Fax:804-763-5407
Practice Address - Street 1:13201 RITTENHOUSE DR
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-6245
Practice Address - Country:US
Practice Address - Phone:804-763-5406
Practice Address - Fax:804-763-5407
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-29
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202208519183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist