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General NPI Number Information
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NPI Number | 1528848132
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Entity Type | Individual
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Provider Name | HENRY JOHNSON
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Gender | Male
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Dates
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Enumeration Date | 10/02/2023
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Last Update Date | 11/03/2023
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Provider Practice Location Address
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Address Line | 5195 N HAMILTON RD
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City | GAHANNA
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State | OH
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Zip | 43230-1313
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Country | US
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Telephone | 614-476-0988
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Fax |
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Provider Business Mailing Address
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Address Line | 8126 REYNOLDSWOOD DR
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City | REYNOLDSBURG
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State | OH
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Zip | 43068-9332
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Country | US
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Telephone | 419-699-0169
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | P10953
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 03443730
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License Number State | OH
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