Provider Demographics
NPI:1902892920
Name:JOHANNIGMAN, MARK J (RPH)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:J
Last Name:JOHANNIGMAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6990 TOWNSHIP ROAD 135
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-9660
Mailing Address - Country:US
Mailing Address - Phone:419-423-5213
Mailing Address - Fax:419-423-5167
Practice Address - Street 1:145 W WALLACE ST
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-1239
Practice Address - Country:US
Practice Address - Phone:419-423-5213
Practice Address - Fax:419-423-5167
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-25231183500000X
IN26017646A183500000X
MI5302032860183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist