Provider Demographics
NPI:1942252564
Name:JOHNSON, CHERYL (PHARMACY TECHNICIAN)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21336 188TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-0440
Mailing Address - Country:US
Mailing Address - Phone:425-432-4288
Mailing Address - Fax:
Practice Address - Street 1:17254 140TH AVE SE
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98058-7014
Practice Address - Country:US
Practice Address - Phone:425-226-7000
Practice Address - Fax:425-235-8796
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA00014686183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician