Provider Demographics
NPI:1962833541
Name:JOHNSON, WILLARD WALTER JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:WILLARD
Middle Name:WALTER
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 1:4284 BOY SCOUT RD NE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-7529
Mailing Address - Country:US
Mailing Address - Phone:330-771-4457
Mailing Address - Fax:
Practice Address - Street 1:4284 BOY SCOUT RD NE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-7529
Practice Address - Country:US
Practice Address - Phone:330-771-4457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-06
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH032260941835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy