Healthcare Provider Details

I. General information

NPI: 1689213829
Provider Name (Legal Business Name): ERIN E JOHNSON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2020
Last Update Date: 01/06/2020
Certification Date: 01/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

0103 MARKET STREET
EAGLE CO
81631
US

IV. Provider business mailing address

PO BOX 6528
EAGLE CO
81631-1007
US

V. Phone/Fax

Practice location:
  • Phone: 970-328-1302
  • Fax:
Mailing address:
  • Phone: 970-691-0383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17784
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: