Provider Demographics
NPI:1831107879
Name:JOHNSON, JAMES KENNETH (RPH)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:KENNETH
Last Name:JOHNSON
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 1:725 N 5TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JACKSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97530-9873
Mailing Address - Country:US
Mailing Address - Phone:541-899-7948
Mailing Address - Fax:541-899-7946
Practice Address - Street 1:725 N 5TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:JACKSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97530-9873
Practice Address - Country:US
Practice Address - Phone:541-899-7948
Practice Address - Fax:541-899-7946
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0008729183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist