Provider Demographics
NPI:1679821714
Name:JOHANEK, JOSEPH (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:JOHANEK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13589 POWAY RD
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-4715
Mailing Address - Country:US
Mailing Address - Phone:858-486-9995
Mailing Address - Fax:858-486-5559
Practice Address - Street 1:13589 POWAY RD
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-4715
Practice Address - Country:US
Practice Address - Phone:858-486-9995
Practice Address - Fax:858-486-5559
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA028090183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARPH-28090OtherSTATE LICENSE