Provider Demographics
NPI:1245997188
Name:JOHNSON, ALEXANDER ADONIS-LEE (CPHT, PSS)
Entity type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:ADONIS-LEE
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:CPHT, PSS
Other - Prefix:MR
Other - First Name:ALEXANDER
Other - Middle Name:ADONIS-LEE
Other - Last Name:JOHNSON-ROBBINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CPHT, PSS
Mailing Address - Street 1:2211 SW 4TH AVE APT 617
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-4938
Mailing Address - Country:US
Mailing Address - Phone:503-714-7976
Mailing Address - Fax:503-506-6472
Practice Address - Street 1:920 SW 6TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-1239
Practice Address - Country:US
Practice Address - Phone:503-714-7976
Practice Address - Fax:503-506-6472
Is Sole Proprietor?:No
Enumeration Date:2021-11-28
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OR175T00000X
ORCPT-0013585183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORCPT-0013585OtherCERTIFIED PHARMACY TECHNICIAN