Provider Demographics
NPI:1831466168
Name:JOHNSON, RONALD B (RPH)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:B
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:RON
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:2538 WILLOW WAY DR
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-3855
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3151 LENORA CHURCH RD STE 600
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30039-4826
Practice Address - Country:US
Practice Address - Phone:678-344-0148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02059600183500000X
GARPH019011183500000X
FLPS26239183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist