Provider Demographics
NPI:1972886588
Name:JOHNSON PIERCE, GWENDOLYN DENISE (RPH)
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:DENISE
Last Name:JOHNSON PIERCE
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 1:956 JONATHAN ST
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:OH
Mailing Address - Zip Code:44001-3131
Mailing Address - Country:US
Mailing Address - Phone:440-985-5521
Mailing Address - Fax:
Practice Address - Street 1:25524 CENTER RIDGE RD
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-4048
Practice Address - Country:US
Practice Address - Phone:440-892-0525
Practice Address - Fax:440-892-1308
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03120543183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist