Provider Demographics
NPI:1780955609
Name:JOHNSON, SHEILA LOUISE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:LOUISE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:SHEILA
Other - Middle Name:LOUISE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:7292 REESE CT
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20187-5817
Mailing Address - Country:US
Mailing Address - Phone:301-254-7113
Mailing Address - Fax:
Practice Address - Street 1:10456 BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-2321
Practice Address - Country:US
Practice Address - Phone:301-937-4020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12370183500000X
PARP037950L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD12370OtherPHARMACIST LICENSE
PARP037950LOtherPHARMACIST LICENSE