Provider Demographics
NPI:1700150414
Name:JOHNSON, MARY FRANCES (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:FRANCES
Last Name:JOHNSON
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 1:3003 ADDY ST
Mailing Address - Street 2:
Mailing Address - City:WASHOUGAL
Mailing Address - State:WA
Mailing Address - Zip Code:98671-2672
Mailing Address - Country:US
Mailing Address - Phone:360-835-0681
Mailing Address - Fax:360-835-0703
Practice Address - Street 1:3003 ADDY ST
Practice Address - Street 2:
Practice Address - City:WASHOUGAL
Practice Address - State:WA
Practice Address - Zip Code:98671-2672
Practice Address - Country:US
Practice Address - Phone:360-835-0681
Practice Address - Fax:360-835-0703
Is Sole Proprietor?:No
Enumeration Date:2012-02-27
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00042173183500000X
ORRPH-0008497183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPH00042173OtherSTATE PHARMACIST LICENSE
ORRPH-0008497OtherSTATE PHARMACIST LICENSE