Healthcare Provider Details

I. General information

NPI: 1346891892
Provider Name (Legal Business Name): MEGAN JOHNSON-BACON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2019
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VETERANS DR
MINNEAPOLIS MN
55417-2309
US

IV. Provider business mailing address

16721 BISCAYNE AVE W
FARMINGTON MN
55024-9516
US

V. Phone/Fax

Practice location:
  • Phone: 612-467-4342
  • Fax:
Mailing address:
  • Phone: 651-399-9862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License NumberP8555
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: