Provider Demographics
NPI:1780906271
Name:JOHNSON, IECHA NATACHA (PHARM D)
Entity type:Individual
Prefix:DR
First Name:IECHA
Middle Name:NATACHA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1052 BIG TORCH ST
Mailing Address - Street 2:
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-1100
Mailing Address - Country:US
Mailing Address - Phone:561-494-3838
Mailing Address - Fax:561-494-2838
Practice Address - Street 1:1760 PALM BEACH LAKES BLVD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-2008
Practice Address - Country:US
Practice Address - Phone:561-847-7481
Practice Address - Fax:561-847-7481
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS40057183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist