MEDICARE: MARK JOHNSON RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	03313397	OH

General Provider Information

NPI Number	:	1023609997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK JOHNSON RPH

Provider Business Mailing Address
First Line	:	13130 SPRINGFIELD RD
Second Line	:
City	:	NEW SPRINGFIELD
State	:	OH
Zip	:	44443-9785
Country	:	US
Telephone Number	:	330-501-3857
Fax Number	:

Provider Business Practice Location Address
First Line	:	10395 MAIN ST
Second Line	:
City	:	NEW MIDDLETOWN
State	:	OH
Zip	:	44442-9717
Country	:	US
Telephone Number	:	330-542-2802
Fax Number	:	330-542-2035

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2021
Last Update Date	:	02/03/2021

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