Provider Demographics
NPI:1447075155
Name:JOHNSON, SOPHIA LOREN (PHARMD)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:LOREN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:488 ALEXANDER LOOP APT 4107
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-6733
Mailing Address - Country:US
Mailing Address - Phone:458-325-8167
Mailing Address - Fax:
Practice Address - Street 1:1210 MOHAWK BLVD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-3349
Practice Address - Country:US
Practice Address - Phone:541-747-3841
Practice Address - Fax:541-747-3896
Is Sole Proprietor?:No
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0020238183500000X
IL051039442183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist