Healthcare Provider Details

I. General information

NPI: 1700174331
Provider Name (Legal Business Name): DAVID JOHNSON PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2011
Last Update Date: 07/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 ELLSWORTH AVE APT B5
PITTSBURGH PA
15232-1757
US

IV. Provider business mailing address

5700 ELLSWORTH AVE APT B5
PITTSBURGH PA
15232-1757
US

V. Phone/Fax

Practice location:
  • Phone: 803-840-3679
  • Fax:
Mailing address:
  • Phone: 803-840-3679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRP444333
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: