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General NPI Number Information
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NPI Number | 1902022981
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Entity Type | Individual
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Provider Name | TERRY DAVID JOHNSON R.PH.
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Gender | Male
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 02/19/2012
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Provider Practice Location Address
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Address Line | 1705 US HIGHWAY 51 AND 138
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City | STOUGHTON
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State | WI
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Zip | 53589-1907
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Country | US
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Telephone | 608-873-7612
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Fax | 608-873-7894
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Provider Business Mailing Address
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Address Line | 1705 US HIGHWAY 51 AND 138
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City | STOUGHTON
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State | WI
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Zip | 53589-1907
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Country | US
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Telephone | 608-873-7612
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Fax | 608-873-7894
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 051-035717
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 14896-040
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 16566
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License Number State | IA
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