MEDICARE: JORDON JOHNSON

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	1835X0200X	Oncology Pharmacist	124443	MN

General Provider Information

NPI Number	:	1588546873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDON JOHNSON

Provider Business Mailing Address
First Line	:	2701 HAYES DR
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55337-1058
Country	:	US
Telephone Number	:	320-333-0028
Fax Number	:

Provider Business Practice Location Address
First Line	:	2701 HAYES DR
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55337-1058
Country	:	US
Telephone Number	:	320-333-0028
Fax Number	:

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

Provider Enumeration Date	:	07/25/2025
Last Update Date	:	07/25/2025

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