Healthcare Provider Details

I. General information

NPI: 1770497521
Provider Name (Legal Business Name): EDNA JOHNSON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EDNA CHAN PHARMD

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 LONE TREE WAY
ANTIOCH CA
94509-6200
US

IV. Provider business mailing address

PO BOX 665
BETHEL ISLAND CA
94511-0665
US

V. Phone/Fax

Practice location:
  • Phone: 925-779-7277
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835E0208X
TaxonomyEmergency Medicine Pharmacist
License Number47996
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: