Provider Demographics
NPI:1740729920
Name:JOHNSON, GERALD RALPH (RPH)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:RALPH
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 214TH ST SE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-4412
Mailing Address - Country:US
Mailing Address - Phone:425-412-6335
Mailing Address - Fax:425-412-6339
Practice Address - Street 1:1909 214TH ST SE
Practice Address - Street 2:SUITE 300
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-4412
Practice Address - Country:US
Practice Address - Phone:425-412-6335
Practice Address - Fax:425-412-6339
Is Sole Proprietor?:No
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00011249183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist