Provider Demographics
NPI:1982903217
Name:JOHNSON, WILLIAM JEFFREY (RPH)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:JEFFREY
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2607 PLUM BROOK CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-7186
Mailing Address - Country:US
Mailing Address - Phone:419-433-6862
Mailing Address - Fax:
Practice Address - Street 1:4580 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:VERMILION
Practice Address - State:OH
Practice Address - Zip Code:44089-3285
Practice Address - Country:US
Practice Address - Phone:440-967-2018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-25
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03215602183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist