Provider Demographics
NPI:1538236237
Name:JOHNSON, STEPHEN CHARLES (RPH)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:CHARLES
Last Name:JOHNSON
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 1:654 GREY EAGLE CIR S
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-1612
Mailing Address - Country:US
Mailing Address - Phone:719-380-5450
Mailing Address - Fax:
Practice Address - Street 1:654 GREY EAGLE CIR S
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-1612
Practice Address - Country:US
Practice Address - Phone:719-380-5450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO16489183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist