Healthcare Provider Details

I. General information

NPI: 1942618574
Provider Name (Legal Business Name): TIMOTHY JOHNSON PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2014
Last Update Date: 04/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 MOAPA VALLEY BOULEVARD
OVERTON NV
89040
US

IV. Provider business mailing address

350 S MOAPA VALLEY BLVD
OVERTON NV
89040
US

V. Phone/Fax

Practice location:
  • Phone: 702-397-2308
  • Fax: 702-397-2348
Mailing address:
  • Phone: 702-397-2308
  • Fax: 702-397-2348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7408750-1701
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19232
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: