Michael Robert Johnson, R.PH.
Individual provider Active NPI Pharmacist · Lake Station, IN
NPI 1124322110 · NPPES record last updated Oct 1, 2025
Key facts
- NPI
- 1124322110
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 26019585A (IN)
- Practice address
- 3500 Central Ave
Lake Station, IN 46405-2271 - Phone
- (219) 963-7355
- Fax
- (219) 963-1562
- NPI assigned
- Jan 5, 2011
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26019585A | IN | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Catherine Hospital Inc | Past |
Accepting new patients | |
| Walgreen Co | Past |
Accepting new patients | |
| Munster Medical Research Foundation, Inc. | Past |
Accepting new patients | |
| Walgreen Co | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 26019585A | IN | Yes |
Addresses
Primary practice location
3500 Central Ave
Lake Station, IN 46405-2271
Mailing address
3500 Central Ave
Lake Station, IN 46405-2271
Phone (219) 963-7355
Other providers in Lake Station, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 1, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.