Healthcare Provider Details

I. General information

NPI: 1164070637
Provider Name (Legal Business Name): STEPHY JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2019
Last Update Date: 08/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2503 WELSH RD
PHILADELPHIA PA
19114-3238
US

IV. Provider business mailing address

1058 DOMINO LN
WARMINSTER PA
18974-2208
US

V. Phone/Fax

Practice location:
  • Phone: 215-671-0544
  • Fax:
Mailing address:
  • Phone: 267-229-3409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP453816
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: