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NPI Code Detail

MEDICARE: MIZUKI JOHNSON

MEDICARE: MIZUKI JOHNSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacistPH61166960WA

General Provider Information

NPI Number : 1760140511
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIZUKI JOHNSON
Provider Business Mailing Address
First Line : 3505 SE 192ND AVE
Second Line :
City : VANCOUVER
State : WA
Zip : 98683-1436
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3505 SE 192ND AVE
Second Line :
City : VANCOUVER
State : WA
Zip : 98683-1436
Country : US
Telephone Number : 360-253-3043
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/29/2021
Last Update Date : 11/29/2021

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Directions to “ MIZUKI JOHNSON ” Practice Location

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