Provider Demographics
NPI:1922095959
Name:JOHNSON, BRENDA SUE (RPH)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:SUE
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 1:22277 MULHOLLAND HWY
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-5156
Mailing Address - Country:US
Mailing Address - Phone:818-223-9475
Mailing Address - Fax:818-223-8750
Practice Address - Street 1:22277 MULHOLLAND HWY
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-5156
Practice Address - Country:US
Practice Address - Phone:818-223-8656
Practice Address - Fax:818-223-8750
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39264183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARPH39264Medicare PIN