Provider Demographics
NPI:1598197113
Name:JOHNSON, SHAWAN BOWE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SHAWAN
Middle Name:BOWE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 AZALEA GARDEN RD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23513-3974
Mailing Address - Country:US
Mailing Address - Phone:757-853-7607
Mailing Address - Fax:
Practice Address - Street 1:2330 AZALEA GARDEN RD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23513-3974
Practice Address - Country:US
Practice Address - Phone:757-853-7607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-06
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202211702183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist