Healthcare Provider Details

I. General information

NPI: 1871212274
Provider Name (Legal Business Name): NATHAN JOHNSON PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2022
Last Update Date: 08/26/2022
Certification Date: 08/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 S MAIN ST
COLFAX WA
99111-1803
US

IV. Provider business mailing address

PO BOX 189
COLFAX WA
99111-0189
US

V. Phone/Fax

Practice location:
  • Phone: 509-397-2111
  • Fax: 509-397-4947
Mailing address:
  • Phone: 509-397-2111
  • Fax: 509-397-4947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60872478
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: