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General NPI Number Information
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NPI Number | 1063338333
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Entity Type | Individual
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Provider Name | JACOB T JOHNSON
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Gender | Male
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Dates
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Enumeration Date | 06/29/2026
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Last Update Date | 06/29/2026
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Provider Practice Location Address
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Address Line | 1005 YELLOWSTONE STREET
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City | FORT PIERRE
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State | SD
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Zip | 57532
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Country | US
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Telephone | 605-280-4481
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Fax |
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Provider Business Mailing Address
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Address Line | 1820 RAND RD
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City | RAPID CITY
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State | SD
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Zip | 57702-9393
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Country | US
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Telephone | 605-280-4481
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P1400X
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Taxonomy Name | Pain Management Pharmacist
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License Number | 22ESTC0839
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License Number State | SD
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Taxonomy #2
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Taxonomy Code | 1835P1400X
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Taxonomy Name | Pain Management Pharmacist
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License Number | 25ESTC1701
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License Number State | SD
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Taxonomy #3
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Taxonomy Code | 1835P1400X
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Taxonomy Name | Pain Management Pharmacist
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License Number | 22ESTC7355
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License Number State | SD
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Taxonomy #4
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Taxonomy Code | 1835P1400X
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Taxonomy Name | Pain Management Pharmacist
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License Number | 22ESTC5017
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License Number State | SD
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Taxonomy #5
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Taxonomy Code | 1835P1400X
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Taxonomy Name | Pain Management Pharmacist
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License Number | 22ESTC8676
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License Number State | SD
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