Provider Demographics
NPI:1023412947
Name:MCCANNA, JOHNIE J (PHARMD)
Entity type:Individual
Prefix:
First Name:JOHNIE
Middle Name:J
Last Name:MCCANNA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 W WELLESLEY AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-5004
Mailing Address - Country:US
Mailing Address - Phone:509-327-2015
Mailing Address - Fax:509-327-2154
Practice Address - Street 1:2301 W WELLESLEY AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-5004
Practice Address - Country:US
Practice Address - Phone:509-327-2015
Practice Address - Fax:509-327-2154
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-21
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60020219183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist