Healthcare Provider Details

I. General information

NPI: 1326452103
Provider Name (Legal Business Name): ERIK JOHNSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2014
Last Update Date: 07/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 WINTHROP ST
REHOBOTH MA
02769-2650
US

IV. Provider business mailing address

181 CEDAR HILL ST
MARLBOROUGH MA
01752-3057
US

V. Phone/Fax

Practice location:
  • Phone: 774-901-2445
  • Fax: 774-565-8481
Mailing address:
  • Phone: 508-624-8880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH24821
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: