Healthcare Provider Details

I. General information

NPI: 1174800262
Provider Name (Legal Business Name): JOSHUA OTIS JOHNSON PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2011
Last Update Date: 09/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 YANKEE DR
EAGAN MN
55121-1627
US

IV. Provider business mailing address

13963 BLUEBIRD ST NW
ANDOVER MN
55304-4052
US

V. Phone/Fax

Practice location:
  • Phone: 651-662-7418
  • Fax:
Mailing address:
  • Phone: 763-331-2139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number119471
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: