Healthcare Provider Details

I. General information

NPI: 1629217187
Provider Name (Legal Business Name): ABOLANLE JOHNSON PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2009
Last Update Date: 05/23/2024
Certification Date: 05/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WALTER REED ARMY MEDICAL CTR 6900 GEORGIA AVENUE NW
WASHINGTON DC
20307-0001
US

IV. Provider business mailing address

WALTER REED ARMY MEDICAL CTR 6900 GEORGIA AVENUE NW
WASHINGTON DC
20307-0001
US

V. Phone/Fax

Practice location:
  • Phone: 202-782-1000
  • Fax:
Mailing address:
  • Phone: 202-486-7912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberA1-0003769
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number18966
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPH100000551
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: