Robert Earl Johnson, RPH
Individual provider Active NPI Pharmacist · Fortuna, CA
NPI 1942372883 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1942372883
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 035667 (CA)
- Practice address
- 1058 Main St
Fortuna, CA 95540-2009 - Phone
- (707) 725-4431
- Fax
- (707) 725-2671
- NPI assigned
- Nov 15, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
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 |
|---|---|---|---|
| 035667 | CA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fortuna Pharmacy Inc | Current | Accepting new patients |
Locations
1058 Main St
Fortuna, CA 95540
Phone (707) 725-4431
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 035667 | CA | Yes |
Addresses
Primary practice location
1058 Main St
Fortuna, CA 95540-2009
Mailing address
1058 Main St
Fortuna, CA 95540-2009
Phone (707) 725-4431
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0544735 | Other | CA | NCPDP |
| PHA372680 | Medicaid | CA |
Other providers in Fortuna, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. 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.