MEDICARE: BOB JOHNSONS PHARMACY

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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	CF00003305	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2108490	OTHER		PK

General Provider Information

NPI Number	:	1932110434
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOB JOHNSONS PHARMACY

Provider Business Mailing Address
First Line	:	1407 NW 85TH ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98117-4237
Country	:	US
Telephone Number	:	206-782-5822
Fax Number	:	206-781-0379

Provider Business Practice Location Address
First Line	:	1407 NW 85TH ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98117-4237
Country	:	US
Telephone Number	:	206-782-5822
Fax Number	:	206-781-0379

Authorized Official
Title or Position	:	OWNER
Name	:	JEFFREY SHANE HARRELL
Credential	:	PHARMD
Telephone Number	:	360-244-5984

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	01/12/2026

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