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General NPI Number Information
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NPI Number | 1982411567
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Entity Type | Individual
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Provider Name | WILLIE L JOHNSON III PHARM D
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Gender | Male
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Dates
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Enumeration Date | 12/17/2024
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Last Update Date | 12/17/2024
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Provider Practice Location Address
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Address Line | 10420 FOREST HILL BLVD
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City | WELLINGTON
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State | FL
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Zip | 33414-3172
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Country | US
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Telephone | 561-791-9218
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Fax |
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Provider Business Mailing Address
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Address Line | 2947 BELLAROSA CIR
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City | WEST PALM BEACH
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State | FL
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Zip | 33411-1467
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Country | US
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Telephone | 561-628-7196
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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 | PS67905
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License Number State | FL
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