Provider Demographics
NPI:1942778535
Name:JOHNSON, THOMAS EUGENE JR (RPH)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:EUGENE
Last Name:JOHNSON
Suffix:JR
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 1:20600 SENECA MEADOWS PKWY
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876-7022
Mailing Address - Country:US
Mailing Address - Phone:240-499-0745
Mailing Address - Fax:240-499-0798
Practice Address - Street 1:20600 SENECA MEADOWS PKWY
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876-7022
Practice Address - Country:US
Practice Address - Phone:240-499-0745
Practice Address - Fax:240-499-0798
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD9603183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist