Provider Demographics
NPI:1780029199
Name:JOHNSON, JARITA MARIE (RPH)
Entity Type:Individual
Prefix:DR
First Name:JARITA
Middle Name:MARIE
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 1:1468 BLACKWOOD CLEMENTON RD
Mailing Address - Street 2:
Mailing Address - City:CLEMENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-5778
Mailing Address - Country:US
Mailing Address - Phone:856-627-0111
Mailing Address - Fax:
Practice Address - Street 1:1468 BLACKWOOD CLEMENTON RD
Practice Address - Street 2:
Practice Address - City:CLEMENTON
Practice Address - State:NJ
Practice Address - Zip Code:08021-5778
Practice Address - Country:US
Practice Address - Phone:856-627-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03553900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI03553900OtherPHARMACY LICENSE