Provider Demographics
NPI:1679229173
Name:AU, JOHNSON (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:JOHNSON
Middle Name:
Last Name:AU
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 N GARFIELD AVE STE D
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-3576
Mailing Address - Country:US
Mailing Address - Phone:626-576-0890
Mailing Address - Fax:
Practice Address - Street 1:103 N GARFIELD AVE STE D
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-3576
Practice Address - Country:US
Practice Address - Phone:626-576-0890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-23
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36931183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA381580Medicaid