Provider Demographics
NPI:1174058580
Name:JOHNSON, NATHANIEL B (PHARM D)
Entity type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:B
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 N BELFAST AVE
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-4363
Mailing Address - Country:US
Mailing Address - Phone:207-622-2626
Mailing Address - Fax:
Practice Address - Street 1:24 LITHGOW ST
Practice Address - Street 2:
Practice Address - City:WINSLOW
Practice Address - State:ME
Practice Address - Zip Code:04901-7149
Practice Address - Country:US
Practice Address - Phone:207-859-9336
Practice Address - Fax:207-859-9345
Is Sole Proprietor?:No
Enumeration Date:2017-04-23
Last Update Date:2017-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR46166183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist