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General NPI Number Information
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NPI Number | 1790073344
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Entity Type | Individual
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Provider Name | MATTHEW JOHNSON PHARMD
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Gender | Male
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Dates
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Enumeration Date | 07/18/2011
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Last Update Date | 07/03/2025
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Provider Practice Location Address
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Address Line | 2907 PLEASANT VALLEY BLVD
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City | ALTOONA
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State | PA
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Zip | 16602-4305
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Country | US
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Telephone | 814-943-8164
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Fax |
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Provider Business Mailing Address
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Address Line | 928 GOLD HILL RD
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City | FORT MILL
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State | SC
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Zip | 29708-7947
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Country | US
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Telephone | 803-548-7197
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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 | 21976
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License Number State | NC
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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 | 13382
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 1835C0207X
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Taxonomy Name | Compounded Sterile Preparations Pharmacist
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License Number | RP455274
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License Number State | PA
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