Provider Demographics
NPI:1609474121
Name:JOHNSON, SEMRA LISA (RPH)
Entity Type:Individual
Prefix:
First Name:SEMRA
Middle Name:LISA
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 1:1960 N FARMING RD
Mailing Address - Street 2:
Mailing Address - City:ARBOR VITAE
Mailing Address - State:WI
Mailing Address - Zip Code:54568-9582
Mailing Address - Country:US
Mailing Address - Phone:715-614-6206
Mailing Address - Fax:
Practice Address - Street 1:8760 NORTHRIDGE WAY
Practice Address - Street 2:
Practice Address - City:MINOCQUA
Practice Address - State:WI
Practice Address - Zip Code:54548-8766
Practice Address - Country:US
Practice Address - Phone:715-356-3782
Practice Address - Fax:715-356-4883
Is Sole Proprietor?:No
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11512183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist