Provider Demographics
NPI:1881078111
Name:JOHNSON, DEBRINA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DEBRINA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:665 N D ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92401-1109
Mailing Address - Country:US
Mailing Address - Phone:909-708-8166
Mailing Address - Fax:093-816-4709
Practice Address - Street 1:665 N D ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92401-1109
Practice Address - Country:US
Practice Address - Phone:909-708-8166
Practice Address - Fax:909-381-6470
Is Sole Proprietor?:No
Enumeration Date:2015-07-16
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA69472183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist