Provider Demographics
NPI:1780944926
Name:JOHNSON, ERIC GREGORY (PHARMD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:GREGORY
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3620 HUMPHREY LN APT 347B
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-3621
Mailing Address - Country:US
Mailing Address - Phone:720-300-8528
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF KENTUCKY MEDICAL CTR
Practice Address - Street 2:HQ 101, 800 ROSE ST
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0001
Practice Address - Country:US
Practice Address - Phone:859-323-9258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2003840390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program