Healthcare Provider Details

I. General information

NPI: 1700307907
Provider Name (Legal Business Name): JARRETT JOHNSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2017
Last Update Date: 01/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2041 GEORGIA AVE NW
WASHINGTON DC
20059-0001
US

IV. Provider business mailing address

5107 7TH ST NW
WASHINGTON DC
20011-4015
US

V. Phone/Fax

Practice location:
  • Phone: 786-718-3803
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH100003058
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: