Matthew Johansen, RPH

Primary specialty

Pharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistTaxonomy code 1835P0018X

License

44362 Issued in TX

Practice address

3510 Altamesa Blvd
Fort Worth, TX 76133-5602

Phone

(817) 292-3777

NPI assigned

Jan 17, 2020

Last updated

Jan 17, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Pharmacist

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Kroger Texas L P

  dba Kroger Pharmacy

  • Community/Retail Pharmacy
  • Fort Worth, TX
  • NPI 1295808723
  NPD (past)
• Kroger Texas LP

  dba Kroger Pharmacy #541

  • Community/Retail Pharmacy
  • Fort Worth, TX
  • NPI 1407747439
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1579219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579219200000",
    "number": "1144850157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3510 ALTAMESA BLVD",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761335602",
            "telephone_number": "817-292-3777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3510 ALTAMESA BLVD",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761335602",
            "telephone_number": "817-292-3777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHANSEN",
        "first_name": "MATTHEW",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-01-17",
        "last_updated": "2020-01-17",
        "certification_date": "2020-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "TX",
            "license": "44362",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Arjun Venkat Jogimahanti, MD
• Sudha R Jogimahanti, M.D.
• Whitney A Johannessen, PNP
• Darla June Johannsen, LVN
• Landrie Michele Johansen, PT, MPT
• Rayann Johanson, LPC-A, M.ED.
• John a Sazy MD PA
• John a. Menchaca, M.D.,P.a.
• John a. Thomas, MD, P.a.
• John Aaron Whitfield, MD, Facog, PA

• Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.