Provider Demographics
NPI:1780707547
Name:JOHNSON, RONALD I (CPHT)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:
Last Name:JOHNSON
Suffix:I
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5546 W MODOC AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-9139
Mailing Address - Country:US
Mailing Address - Phone:559-635-0710
Mailing Address - Fax:
Practice Address - Street 1:3710 SOUTHWEST US VETERANS HOSPITAL ROAD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239
Practice Address - Country:US
Practice Address - Phone:559-635-0710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CATCH 72056183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician