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NPI Code Detail

MEDICARE: RONALD BERNARD JOHNSON RPH

MEDICARE: RONALD BERNARD 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
1183500000XPharmacist111213-3MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1111213-3OTHERFMPHARMACY LIC

General Provider Information

NPI Number : 1689747628
Entity Type Code : Individual
Provider Name (Legal Business Name) : RONALD BERNARD JOHNSON RPH
Provider Business Mailing Address
First Line : 1280 NURSERY HILL CT
Second Line :
City : ARDEN HILLS
State : MN
Zip : 55112-5766
Country : US
Telephone Number : 651-639-0610
Fax Number : 651-647-9730
Provider Business Practice Location Address
First Line : 720 SNELLING AVE N
Second Line :
City : SAINT PAUL
State : MN
Zip : 55104-1844
Country : US
Telephone Number : 651-645-8636
Fax Number : 651-647-9730
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/16/2006
Last Update Date : 07/08/2007

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