Healthcare Provider Details

I. General information

NPI: 1578770327
Provider Name (Legal Business Name): JEREMY LOWELL JOHNSON PHARM. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4502 E 41ST ST SUITE 2H29
TULSA OK
74135-2553
US

IV. Provider business mailing address

2009 W 119TH ST S
JENKS OK
74037-4380
US

V. Phone/Fax

Practice location:
  • Phone: 918-660-3007
  • Fax: 918-660-3009
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number12853
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: