Healthcare Provider Details

I. General information

NPI: 1710816038
Provider Name (Legal Business Name): CORY JOHNSON PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 IRVING ST NW
WASHINGTON DC
20010-3017
US

IV. Provider business mailing address

515 5TH ST SE
WASHINGTON DC
20003-4206
US

V. Phone/Fax

Practice location:
  • Phone: 202-877-7406
  • Fax:
Mailing address:
  • Phone: 202-297-6929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835C0205X
TaxonomyCritical Care Pharmacist
License NumberPH100000314
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: