Healthcare Provider Details

I. General information

NPI: 1639626989
Provider Name (Legal Business Name): ERIK JOHNSEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2016
Last Update Date: 09/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 N 45TH ST
SEATTLE WA
98103-6803
US

IV. Provider business mailing address

4025 DELRIDGE WAY SW #400
SEATTLE WA
98106-1249
US

V. Phone/Fax

Practice location:
  • Phone: 206-632-3314
  • Fax:
Mailing address:
  • Phone: 206-763-2626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60662681
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: