Healthcare Provider Details

I. General information

NPI: 1780707547
Provider Name (Legal Business Name): RONALD JOHNSON I CPHT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3710 SOUTHWEST US VETERANS HOSPITAL ROAD
PORTLAND OR
97239
US

IV. Provider business mailing address

5546 W MODOC AVE
VISALIA CA
93291-9139
US

V. Phone/Fax

Practice location:
  • Phone: 559-635-0710
  • Fax:
Mailing address:
  • Phone: 559-635-0710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberTCH 72056
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: