Healthcare Provider Details

I. General information

NPI: 1932352416
Provider Name (Legal Business Name): HEATHER RACHELLE JOHNSON PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2008
Last Update Date: 10/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 OGLETOWN STANTON RD
NEWARK DE
19718-0001
US

IV. Provider business mailing address

4721 WEATHERHILL DR
WILMINGTON DE
19808-1938
US

V. Phone/Fax

Practice location:
  • Phone: 302-733-6364
  • Fax:
Mailing address:
  • Phone: 302-234-1710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberA1-0003583
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number16936
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: