Provider Demographics
NPI:1942411624
Name:JOHANSEN, ROBIN E (RPH)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:E
Last Name:JOHANSEN
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 1:1115 HARRIS AVE
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-7036
Mailing Address - Country:US
Mailing Address - Phone:360-734-3340
Mailing Address - Fax:360-734-3750
Practice Address - Street 1:1115 HARRIS AVE
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-7036
Practice Address - Country:US
Practice Address - Phone:360-734-3340
Practice Address - Fax:360-734-3750
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACF00004023183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist