MEDICARE: DR. JEREMY LOREN JOHNSON PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	117762-8	MN

General Provider Information

NPI Number	:	1225031685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEREMY LOREN JOHNSON PHARM.D.

Provider Business Mailing Address
First Line	:	800 27TH ST SW
Second Line	:
City	:	AUSTIN
State	:	MN
Zip	:	55912-5400
Country	:	US
Telephone Number	:	507-434-0842
Fax Number	:

Provider Business Practice Location Address
First Line	:	1707 2ND ST SW
Second Line	:
City	:	AUSTIN
State	:	MN
Zip	:	55912-1985
Country	:	US
Telephone Number	:	507-434-0842
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	03/29/2020

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