Provider Demographics
NPI:1457971194
Name:SIERRA, JOHANNA C
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:C
Last Name:SIERRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOHANNA
Other - Middle Name:C
Other - Last Name:RITCHIE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:11367 AMERICAN HOLLY DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-0026
Mailing Address - Country:US
Mailing Address - Phone:954-775-5639
Mailing Address - Fax:
Practice Address - Street 1:5905 US HIGHWAY 301 S
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-3800
Practice Address - Country:US
Practice Address - Phone:813-740-8473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-22
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS52815183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist