Provider Demographics
NPI:1841587763
Name:JOHNSON, LUKE (PHARM D)
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3649 S HASTINGS WAY
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-8182
Mailing Address - Country:US
Mailing Address - Phone:715-838-0447
Mailing Address - Fax:715-838-0447
Practice Address - Street 1:3649 S HASTINGS WAY
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-8182
Practice Address - Country:US
Practice Address - Phone:715-838-0447
Practice Address - Fax:715-838-0447
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14937-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist