Individual
ELLIE MAE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
105 NW 13TH AVE, PORTLAND, OR 97209-4110
(503) 327-0233
Mailing address
105 NW 13TH AVE, PORTLAND, OR 97209-4110
(503) 327-0233
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH-0017856
OR
Other
Enumeration date
12/08/2020
Last updated
12/08/2020
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