Provider Demographics
NPI:1619204443
Name:JOHNSON, A NICOLE (RPH)
Entity Type:Individual
Prefix:MS
First Name:A
Middle Name:NICOLE
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 1:16731 INNISBROOK DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-6575
Mailing Address - Country:US
Mailing Address - Phone:281-345-3050
Mailing Address - Fax:281-256-0247
Practice Address - Street 1:11803 BARKER CYPRESS RD
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-1865
Practice Address - Country:US
Practice Address - Phone:281-304-5097
Practice Address - Fax:281-256-0247
Is Sole Proprietor?:No
Enumeration Date:2009-11-16
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX356361835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist